Provider Demographics
NPI:1780654376
Name:ANDERSON, DALE C (DPM)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6801 US HIGHWAY 27 N
Mailing Address - Street 2:#D3
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7840
Mailing Address - Country:US
Mailing Address - Phone:863-314-8600
Mailing Address - Fax:863-314-8556
Practice Address - Street 1:6801 US HIGHWAY 27 N
Practice Address - Street 2:#D3
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-314-8600
Practice Address - Fax:863-314-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2915213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9942617OtherCIGNA
FLN232158OtherHEALTHEASE KID CARE
FL16669OtherFL HOSPITAL HEALTHCARE SY
FL65709OtherBLUE CROSS BLUE SHIELD
FLP00158441OtherRAILROAD MEDICARE
FL340223100Medicaid
FL002122232OtherUNITED HEALTHCARE
FL9942617OtherCIGNA
FL65709ZMedicare PIN