=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508972290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALE R WRIGHT V DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 05/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 S SHORE CENTER W 103E
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-521-0441
-----------------------------------------------------
Fax | 510-521-7473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 S SHORE CTR W 103E
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-521-0441
-----------------------------------------------------
Fax | 510-521-7473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 000E18670
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | E1867
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------