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Individual
DALE BROOME
Active
Individual
DALE BROOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004286
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004286
LICENSE NUMBER
GA
05
—
584584358A
—
GA
Enumeration date
11/09/2006
Last updated
06/07/2022
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