Provider Demographics
NPI:1497797906
Name:DAHLE, DANIEL BLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BLAINE
Last Name:DAHLE
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0277
Mailing Address - Country:US
Mailing Address - Phone:530-294-5241
Mailing Address - Fax:530-294-5801
Practice Address - Street 1:554-850 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BIEBER
Practice Address - State:CA
Practice Address - Zip Code:96009-0277
Practice Address - Country:US
Practice Address - Phone:530-294-5241
Practice Address - Fax:530-294-5801
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine