Provider Demographics
NPI:1063403244
Name:MESSER, DALE LEONARD (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:LEONARD
Last Name:MESSER
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 1:711 W SIDNOR ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2168
Mailing Address - Country:US
Mailing Address - Phone:281-331-5953
Mailing Address - Fax:281-331-2221
Practice Address - Street 1:711 W SIDNOR ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2168
Practice Address - Country:US
Practice Address - Phone:281-331-5953
Practice Address - Fax:281-331-2221
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135530707Medicaid
85J236Medicare ID - Type Unspecified
TX135530707Medicaid