Provider Demographics
NPI:1427095165
Name:DALE, PAUL STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:STEPHEN
Last Name:DALE
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 1:800 1ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8308
Mailing Address - Country:US
Mailing Address - Phone:478-633-6900
Mailing Address - Fax:478-633-2175
Practice Address - Street 1:800 1ST ST STE 240
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8308
Practice Address - Country:US
Practice Address - Phone:478-633-6900
Practice Address - Fax:478-633-2175
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0330632086X0206X
MO20040215832086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO671369OtherHEALTHLINK
MO3600597OtherUNITED HEALTHCARE
MO191532OtherBLUE SHIELD
MO191532OtherBLUE CHOICE
GA033063OtherGA MEDICAL LICENSE
MO208822908Medicaid
MOF66905Medicare UPIN
MO924011108Medicare PIN
MO924015236Medicare PIN
MO671369OtherHEALTHLINK
MOP00430558Medicare PIN