Basic Information
| Provider Information | |||||||||
| NPI: | 1497797906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAHLE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | BLAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277 | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302945241 | ||||||||
| FaxNumber: | 5302945801 | ||||||||
| Practice Location | |||||||||
| Address1: | 554-850 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302945241 | ||||||||
| FaxNumber: | 5302945801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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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 | 207Q00000X | 653557 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.