Provider Demographics
NPI:1043382336
Name:BRENTLINGER, DALE C (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:C
Last Name:BRENTLINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 E FOX FARM ROAD
Mailing Address - Street 2:#1A
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007
Mailing Address - Country:US
Mailing Address - Phone:307-635-3618
Mailing Address - Fax:307-635-1442
Practice Address - Street 1:2508 E FOX FARM ROAD
Practice Address - Street 2:#1A
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007
Practice Address - Country:US
Practice Address - Phone:307-635-3618
Practice Address - Fax:307-635-1442
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY2995A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYA73001Medicare UPIN