Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 033063 | GA |
NPI | 1427095165 |
---|---|
Provider Name | Paul Stephen Dale |
First Address | Macon, GA 31201-8308 |
Second Address | Macon, GA 31201-8308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F66905 | (02) | MO |