Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 000E18670 | CA |
N | 222Z00000X | Podiatrist | 000E18670 | CA |
Y | 213EP1101X | Primary Podiatric Medicine | E1867 | CA |
NPI | 1508972290 |
---|---|
Provider Name | Dr. Dale R Wright V |
First Address | Alameda, CA 94501 |
Second Address | Alameda, CA 94501-2972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E18670 | (05) | CA |
T11082 | (02) | CA |