Basic Information
| Provider Information | |||||||||
| NPI: | 1477617686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDOWELL | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2614 CLOVER ST | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418846233 | ||||||||
| FaxNumber: | 5418802840 | ||||||||
| Practice Location | |||||||||
| Address1: | 2614 CLOVER ST | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418846233 | ||||||||
| FaxNumber: | 5418802840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 01/06/2010 | ||||||||
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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 | 207RI0011X | MD11676 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 060029403 | 01 | OR | RAILROAD MEDICARE | OTHER | 245522 | 05 | OR | MEDICAID | 060063048 | 01 | OR | RAILROAD MEDICARE | OTHER | 060061454 | 01 | OR | RAILROAD MEDICARE | OTHER |