Provider Demographics
NPI:1326060831
Name:FURUKAWA, DALE (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:FURUKAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7980 CLAYTON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1354
Mailing Address - Country:US
Mailing Address - Phone:314-951-5368
Mailing Address - Fax:314-951-5238
Practice Address - Street 1:505 COUCH AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-5568
Practice Address - Country:US
Practice Address - Phone:314-965-5868
Practice Address - Fax:314-965-0713
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7P40207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F53360Medicare UPIN