Dale P Fanney, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23420 Issued in WI

Practice address

160 Valley Dr
Lodi, WI 53555-1464

Phone

(608) 592-3296

NPI assigned

Feb 22, 2006

Last updated

Jun 7, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275868800000",
    "number": "1508831413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 VALLEY DR",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551464",
            "telephone_number": "608-592-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 VALLEY DR",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551464",
            "telephone_number": "608-592-3296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNEY",
        "first_name": "DALE",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2010-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "23420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080051114",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30344600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea M Chao, MD
• Joel Robert Cooper, D.C.
• Joel Patrick Crane, DDS
• Divine Rehabilitation and Nursing at Lodi LLC
• David J Eberdt, PA
• Melissa Faubert, D.O.
• Daryn Joseph Flentje, RN
• Jean Elizabeth Gates, OTR
• Cassandra Lea Haak, APRN
• Stacey Lee Hamre, RN

• Family Medicine Physician in Lodi, WI
• Providers in Lodi, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2010; 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.