MEDICARE: MR. DALE RAY STIERWALT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	13506	AL

General Provider Information

NPI Number	:	1144204843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE RAY STIERWALT MD

Provider Business Mailing Address
First Line	:	1618 GAULT AVE NORTH
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967
Country	:	US
Telephone Number	:	256-845-1311
Fax Number	:	256-845-1346

Provider Business Practice Location Address
First Line	:	1618 GAULT AVE. N.
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967
Country	:	US
Telephone Number	:	256-845-1311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/01/2010

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