Provider Demographics
NPI:1669622593
Name:VANKIRK, DALE HERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:HERMAN
Last Name:VANKIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 RANCHO VISTA CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-9412
Mailing Address - Country:US
Mailing Address - Phone:408-848-3255
Mailing Address - Fax:
Practice Address - Street 1:401 E CARRILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1460
Practice Address - Country:US
Practice Address - Phone:805-563-3307
Practice Address - Fax:805-563-0998
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38376207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery