Provider Demographics
NPI:1174505119
Name:BLOCK, DALE J (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:BLOCK
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 1:4859 NIXON PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8106
Mailing Address - Country:US
Mailing Address - Phone:513-492-5940
Mailing Address - Fax:513-492-5941
Practice Address - Street 1:4859 NIXON PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8106
Practice Address - Country:US
Practice Address - Phone:513-492-5940
Practice Address - Fax:513-492-5941
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81500207Q00000X
OH35.058139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059525Medicaid
FL000235000Medicaid
OHH060650Medicare PIN
FL000235000Medicaid
FLE76481Medicare PIN