Provider Demographics
NPI:1548705593
Name:DALE, GARY ERNEST (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ERNEST
Last Name:DALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 1ST AVE SW
Mailing Address - Street 2:P.O. BOX 483
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-9376
Mailing Address - Country:US
Mailing Address - Phone:406-540-3188
Mailing Address - Fax:
Practice Address - Street 1:106 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-9376
Practice Address - Country:US
Practice Address - Phone:406-540-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6580207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology