Provider Demographics
NPI:1497785612
Name:ADISHIAN, DALE ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ALLEN
Last Name:ADISHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:504 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3727
Mailing Address - Country:US
Mailing Address - Phone:406-823-6414
Mailing Address - Fax:406-823-6287
Practice Address - Street 1:1315 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3350
Practice Address - Country:US
Practice Address - Phone:406-222-9970
Practice Address - Fax:406-222-9971
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT11500207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47811Medicare UPIN