Provider Demographics
NPI:1790864080
Name:DALE, REBECCA C (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:C
Last Name:DALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9175
Mailing Address - Country:US
Mailing Address - Phone:425-292-0716
Mailing Address - Fax:425-292-9641
Practice Address - Street 1:126 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-9175
Practice Address - Country:US
Practice Address - Phone:425-831-2020
Practice Address - Fax:425-831-0027
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047608207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1037874Medicaid
WA2005971Medicaid
WAP00806368OtherRAILROAD MEDICARE PTAN
WA8159SNOtherREGENCE
WA2005971Medicaid
WA5026560001Medicare NSC