Provider Demographics
NPI:1194948562
Name:VALLEY EAR NOSE AND ALLERGY GROUP
Entity type:Organization
Organization Name:VALLEY EAR NOSE AND ALLERGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-782-1871
Mailing Address - Street 1:198 W CHERRY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3506
Mailing Address - Country:US
Mailing Address - Phone:559-782-1871
Mailing Address - Fax:559-782-1874
Practice Address - Street 1:198 W CHERRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3506
Practice Address - Country:US
Practice Address - Phone:559-782-1871
Practice Address - Fax:559-782-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18002207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088640Medicaid
CAGR0088640Medicaid
CAGR0088640Medicaid