Provider Demographics
NPI:1215041652
Name:DALE, ROBERT A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:DALE
Suffix:JR
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 1:110 RAVENWOOD CV
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-7091
Mailing Address - Country:US
Mailing Address - Phone:662-840-4648
Mailing Address - Fax:662-844-0315
Practice Address - Street 1:1105 EARL FRYE BOULEVARD
Practice Address - Street 2:GILMORE MEMORIAL HOSPITAL
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821
Practice Address - Country:US
Practice Address - Phone:662-256-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist