Provider Demographics
NPI:1255492765
Name:DALE, ANDREW MONTGOMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MONTGOMERY
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 1:207 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1511
Mailing Address - Country:US
Mailing Address - Phone:979-739-9343
Mailing Address - Fax:
Practice Address - Street 1:207 LAKE RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1511
Practice Address - Country:US
Practice Address - Phone:979-475-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine