Provider Demographics
NPI:1114489309
Name:DAILEY, ADELE J (IDMT)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:J
Last Name:DAILEY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 2022
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96264
Mailing Address - Country:US
Mailing Address - Phone:315-872-4224
Mailing Address - Fax:
Practice Address - Street 1:UNIT 2022
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96264-2022
Practice Address - Country:US
Practice Address - Phone:315-782-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians