Individual
DALE INTIHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
309 PALM COAST PKWY NE, PALM COAST, FL 32137-3886
(386) 445-7073
(386) 447-7092
Mailing address
PO BOX 9671, DAYTONA BEACH, FL 32120
(386) 676-7130
(386) 676-7125
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME89456
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164490199
TRICARE
FL
05
—
268950200
—
FL
01
—
37624
BCBS
FL
01
—
ME89456
VHN
FL
01
—
P01034306
RAILROAD
FL
Enumeration date
03/08/2006
Last updated
02/22/2016
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