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General NPI Number Information
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NPI Number | 1962832923
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Entity Type | Individual
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Provider Name | DALE MCKAY BELNAP PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 444 HOSPITAL WAY STE 710
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City | POCATELLO
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State | ID
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Zip | 83201-2745
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Country | US
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Telephone | 208-235-4263
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Fax | 208-233-4268
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Provider Business Mailing Address
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Address Line | 444 HOSPITAL WAY STE 710
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City | POCATELLO
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State | ID
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Zip | 83201-2745
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Country | US
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Telephone | 208-235-4263
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Fax | 208-233-4268
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | TLP-019
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA-1133
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License Number State | ID
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