Basic Information
| Provider Information | |||||||||
| NPI: | 1407928369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIETHOLTER | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8782 ESTATE DR | ||||||||
| Address2: | |||||||||
| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334116592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617910376 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2007 PALM BEACH LAKES BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334096501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614208555 | ||||||||
| FaxNumber: | 8884426078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 04/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME25941 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.