Provider Demographics
NPI:1235295627
Name:DALE R STIERWALT MD PC
Entity Type:Organization
Organization Name:DALE R STIERWALT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STIERWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-845-1311
Mailing Address - Street 1:1618 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3328
Mailing Address - Country:US
Mailing Address - Phone:256-845-1311
Mailing Address - Fax:256-845-1346
Practice Address - Street 1:1618 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3328
Practice Address - Country:US
Practice Address - Phone:256-845-1311
Practice Address - Fax:256-845-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013506305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70431Medicare UPIN