Provider Demographics
NPI:1962468553
Name:DIAL, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:117 PIRIE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3166
Mailing Address - Country:US
Mailing Address - Phone:805-646-7246
Mailing Address - Fax:805-646-8936
Practice Address - Street 1:117 PIRIE RD
Practice Address - Street 2:SUITE D
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3166
Practice Address - Country:US
Practice Address - Phone:805-646-7246
Practice Address - Fax:805-646-8936
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49311YMedicaid
CAYYY49311YMedicaid
CAWG48638BMedicare PIN