DALE W BLAISE (NPI# 1770557472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770557472 |
| Entity Type | Individual |
| Full Name | DALE W BLAISE |
| Credential | MD |
| Practice Address |
19 E Shawnee Drive Murphysboro IL 62966 |
| Mailing Address |
Po Box 3988 Carbondale IL 62902-3988 |
| Practice Telephone | 6186842172 |
| Practice Fax Number | 6186874480 |
| Mailing Telephone | 6184575200 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-10-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036065426 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MULTI PLAN | 8630880 | 01 |
| IL | BCBS | 3932056 | 01 |
| IL | AETNA | 7210895 | 01 |
| IL | 036065426 | 05 |
| Street Address |
19 E SHAWNEE DRIVE |
| City | MURPHYSBORO |
| State | IL |
| Zip Code | 62966 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255305967 | Amanda S Sailliez | Physician Assistant | 19 E Shawnee Drive, Murphysboro, IL 62966 | 2006-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093272999 | Lifenet, Inc. | Ambulance | 430 N Airport Rd, Murphysboro, IL 62966 | 2019-02-27 |
| 1538678354 | Anita Tallegien Daneshdoost | Physical Therapist | 1725 Shomaker Drive, Murphysboro, IL 62966 | 2017-09-25 |
| 1295281558 | Alternatives Counseling Inc. | Community/Behavioral Health | 1400 N Wood Road, Murphysboro, IL 62966 | 2016-08-28 |
| 1962855833 | Andrea Maren Whipple | Counselor | 617 Walnut St, Murphysboro, IL 62966 | 2016-07-15 |
| 1730544180 | Lasharon Smith | Non-emergency Medical Transport (VAN) | 37 Nins Lane, Murphysboro, WI 62966 | 2015-12-29 |
| 1710241328 | Kati K Rush | Podiatrist | 19 E Shawnee Dr Ste 3, Murphysboro, IL 62966 | 2012-06-28 |
| 1386709418 | Hoai P Nguyen | Dentist | 1116 Locust Street, Murphysboro, IL 62966 | 2006-12-27 |
| 1154416576 | Hayley Autumn Hood | Occupational Therapist | 6 East Shawnee, Murphysboro, IL 62966 | 2006-10-03 |
| 1356435135 | Southern Illinois Hospital Services | General Acute Care Hospital | 2 South Hospital Drive, Murphysboro, IL 62966 | 2006-10-03 |
| 1699879825 | Stephen Craig Mills | Chiropractor | 1010 N 14th St, Murphysboro, IL 62966 | 2006-09-08 |
| Find all providers in zip 62966 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689780876 | Evan Tep Belfer | Family Medicine | 801 N 14th St, Murphysboro, IL 62966 | 2006-08-22 |
| 1760426316 | Todd Smith | Family Medicine | 7 South Hospital Drive, Murphysboro, IL 62966-3333 | 2006-06-15 |
| 1932146271 | Clare T Williams | Family Medicine | 7 S Hospital Dr, Murphysboro, IL 62966-3333 | 2006-06-02 |
| 1528035821 | Medical Arts Clinic Ltd | Family Medicine | 19 E Shawnee Dr, Murphysboro, IL 62966-7049 | 2006-03-06 |
| 1023083748 | Emily D Hanson | Family Medicine | 19 E Shawnee Dr Ste 2, Murphysboro, IL 62966-7072 | 2006-02-17 |
| 1710586128 | Jessica N Rigg | Family Medicine | 7 S Hospital Dr, Murphysboro, IL 62966-3333 | 2020-10-19 |
| 1447455019 | Ana L Risse | Family Medicine | 7 S Hospital Dr, Murphysboro, IL 62966-3333 | 2007-06-15 |
| 1982773701 | Donald W Porter | Family Medicine | 628 N 14th St, Murphysboro, IL 62966-1807 | 2006-11-07 |
| 1306869557 | Jeffrey Ripperda | Family Medicine | 7 South Hospital Drive, Murphysboro, IL 62966-3333 | 2006-07-26 |
| 1245260645 | Shawnee Health Service and Development Corp | Family Medicine | 7 South Hospital Drive, Murphysboro, IL 62966-3333 | 2006-07-03 |
| Find all providers in MURPHYSBORO | ||||
| City | MURPHYSBORO |
| Zip Code | 62966 |
Please comment or provide details below to improve the information on DALE W BLAISE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.