Provider Demographics
NPI:1285624502
Name:DALEY, PATRICK DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DENNIS
Last Name:DALEY
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 1:3008 SILLECT AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6340
Mailing Address - Country:US
Mailing Address - Phone:661-616-9300
Mailing Address - Fax:661-616-9301
Practice Address - Street 1:3008 SILLECT AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6340
Practice Address - Country:US
Practice Address - Phone:661-616-9300
Practice Address - Fax:661-616-9301
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34597207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45994Medicare UPIN
CAZZZ11832ZMedicare ID - Type Unspecified