Provider Demographics
NPI:1922034479
Name:LACROIX, DALE JEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:JEANNE
Last Name:LACROIX
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 1:10601 E GOLD PANNING CT
Mailing Address - Street 2:
Mailing Address - City:COLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85518-5110
Mailing Address - Country:US
Mailing Address - Phone:802-233-3802
Mailing Address - Fax:
Practice Address - Street 1:159 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1013
Practice Address - Country:US
Practice Address - Phone:814-362-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010133207V00000X
CT62063207V00000X
RIMD19859207V00000X
OH35.144459207VX0000X
PAMD473007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2427Medicaid
VT0VN2427Medicaid
VT0VN2427Medicaid
VTNX0495Medicare PIN
VTVN2427Medicare PIN