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General NPI Number Information
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NPI Number | 1639757958
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Entity Type | Individual
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Provider Name | MAURICE DEON DALE
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Gender | Male
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 1 SAINT ELIZABETH BLVD
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City | O FALLON
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State | IL
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Zip | 62269-1099
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Country | US
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Telephone | 618-234-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E MARKET ST
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City | AKRON
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State | OH
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Zip | 44304-1619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036170338
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License Number State | IL
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