Provider Demographics
NPI:1306220629
Name:HOUSER, DALE (PA-C)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:HOUSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIVISION OF BURN TRAUMA
Mailing Address - Street 2:BOX 100108
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0108
Mailing Address - Country:US
Mailing Address - Phone:352-273-5670
Mailing Address - Fax:
Practice Address - Street 1:DIVISION OF BURN TRAUMA
Practice Address - Street 2:BOX 100108
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0108
Practice Address - Country:US
Practice Address - Phone:352-273-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015588300Medicaid
FL015588300Medicaid