Provider Demographics
NPI:1699785402
Name:DALRYMPLE, GERALD E (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:DALRYMPLE
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 1:2428 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE LL
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2045
Mailing Address - Country:US
Mailing Address - Phone:310-315-1000
Mailing Address - Fax:310-829-0348
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:SUITE LL
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2045
Practice Address - Country:US
Practice Address - Phone:310-315-1000
Practice Address - Fax:310-829-0348
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G124140Medicaid
CA9747031Medicare UPIN
CATP003Medicare ID - Type Unspecified