Provider Demographics
NPI:1861457632
Name:WARE, DANA S (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:S
Last Name:WARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:96020-1460
Mailing Address - Country:US
Mailing Address - Phone:530-258-3329
Mailing Address - Fax:530-258-2004
Practice Address - Street 1:199 REYNOLDS RD.
Practice Address - Street 2:130 BRENTWOOD DR.
Practice Address - City:CHESTER
Practice Address - State:CA
Practice Address - Zip Code:96020
Practice Address - Country:US
Practice Address - Phone:530-258-3329
Practice Address - Fax:530-258-2004
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55407171100000X, 207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G554070Medicaid
CA00G554070Medicaid
A52947Medicare UPIN