Dale L. Syverson, MD, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G87246 Issued in CA

Legal business name

DALE L. SYVERSON, MD, INC

Practice address

1825 Main St
Susanville, CA 96130-4518

Phone

(530) 252-4115

Fax

(530) 252-4116

NPI assigned

Apr 28, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teresa Maria Garate

Title

Office Manager

Phone

(530) 252-4115

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dale L. Syverson Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1154612869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 MAIN ST",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961304518",
            "telephone_number": "530-252-4115",
            "fax_number": "530-252-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 MAIN ST",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961304518",
            "telephone_number": "530-252-4115",
            "fax_number": "530-252-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALE L. SYVERSON, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "GARATE",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "530-252-4115"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G87246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9386136",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dale L. Syverson",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Specialist in Susanville, CA
• Providers in Susanville, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.