Basic Information
| Provider Information | |||||||||
| NPI: | 1851377915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 SOUTH LIMESTONE STREET | ||||||||
| Address2: | UHS B-163 KENTUCKY CLINIC | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235823 | ||||||||
| FaxNumber: | 8593231119 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 SOUTH LIMESTONE STREET | ||||||||
| Address2: | UHS B-163 KENTUCKY CLINIC | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235823 | ||||||||
| FaxNumber: | 8593231119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 16779 | KY | X | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 16779 | KY | X | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64167794 | 05 | KY | MEDICAID |