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General NPI Number Information
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NPI Number | 1992768469
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Entity Type | Individual
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Provider Name | DALE E VIZCARRA MD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 100 MAC LANE AVERA MEDICAL GROUP PIERRE
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City | PIERRE
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State | SD
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Zip | 57501
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Country | US
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Telephone | 605-224-5901
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Fax | 605-945-5096
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Provider Business Mailing Address
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Address Line | 100 MAC LANE AVERA MEDICAL GROUP PIERRE
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City | PIERRE
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State | SD
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Zip | 57501
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Country | US
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Telephone | 605-224-5901
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Fax | 605-945-5096
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3600
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SD3600
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License Number State | SD
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