Provider Demographics
NPI:1659441947
Name:DALE T HERRIOTT MD INC
Entity Type:Organization
Organization Name:DALE T HERRIOTT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-327-0739
Mailing Address - Street 1:6401 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0613
Mailing Address - Country:US
Mailing Address - Phone:661-327-0739
Mailing Address - Fax:661-631-2210
Practice Address - Street 1:6401 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0613
Practice Address - Country:US
Practice Address - Phone:661-327-0739
Practice Address - Fax:661-631-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G346440Medicaid
CA00G346440Medicare ID - Type UnspecifiedMEDICARE