Blaise, Dale W

Blaise, Dale W is an individual health care provider with primary practice located at 19 E Shawnee Dr Ste 2 , Murphysboro IL 62966-7072. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Blaise, Dale W can be contacted via phone (618) 684-2172.

Contact Information

Primary practice address
19 E Shawnee Dr Ste 2 Murphysboro IL 62966-7072
Phone: (618) 684-2172
Fax: (618) 687-4480
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036065426 Illinois

Profile Details

NPI number 1770557472
LBN Legal business name Blaise, Dale W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 17th, 2006
Last updated Aug 24th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770557472 NPPES
Illinois MEDICAID 036065426
Illinois Other 7210895
Illinois Other 3932056
Illinois Other 8630880

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