MEDICARE: DR. LORING GREGG DALES M.D.

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	2083P0901X	Public Health & General Preventive Medicine Physician	G15865	CA

General Provider Information

NPI Number	:	1497946164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORING GREGG DALES M.D.

Provider Business Mailing Address
First Line	:	544 VINCENTE AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-1522
Country	:	US
Telephone Number	:	510-524-8375
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 VINCENTE AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-1522
Country	:	US
Telephone Number	:	510-524-8375
Fax Number	:

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

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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