Provider Demographics
NPI:1487663472
Name:DIERBERG, DALE F (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:F
Last Name:DIERBERG
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 1:2753 AUTUMN RUN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-7030
Mailing Address - Country:US
Mailing Address - Phone:636-227-6839
Mailing Address - Fax:
Practice Address - Street 1:509 WEST EIGHTEENTH STREET
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041
Practice Address - Country:US
Practice Address - Phone:573-486-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO327062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004136255OtherAETNA
MO8076OtherGHP
MO1207907OtherFIRST HEALTH
MO3201OtherHCUSA
MO784OtherBLUE SHIELD
MO3079111OtherCIGNA
MO0004136255OtherAETNA