Provider Demographics
NPI:1396935631
Name:KLEPZIG, DALE ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:ROBERT
Last Name:KLEPZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-8721
Mailing Address - Fax:903-577-0640
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2338
Practice Address - Country:US
Practice Address - Phone:903-572-8741
Practice Address - Fax:903-577-0640
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0116016615208600000X
TXN7935208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2124422-04Medicaid