Basic Information
Provider Information
NPI: 1003989054
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOLAN
FirstName: DAVID
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2757
Address2:  
City: ORANGE
State: CA
PostalCode: 928590757
CountryCode: US
TelephoneNumber: 7149732650
FaxNumber: 7149732655
Practice Location
Address1: 39700 BOB HOPE DR STE 301
Address2:  
City: RANCHO MIRAGE
State: CA
PostalCode: 922707129
CountryCode: US
TelephoneNumber: 7603467696
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/16/2006
LastUpdateDate: 10/04/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XG21271CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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