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Individual

DR. DALE ETHAN EKSTRUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
217 WEST CENTRAL AVENUE, SUITE G, LOMPOC, CA 93436-2830
(805) 735-4292
(805) 735-4293
Mailing address
117 WEST BUNNY AVENUE, SANTA MARIA, CA 93458-2805
(805) 735-4292
(805) 735-4293

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G69286
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CB207338
MEDICARE ID
CA
Enumeration date
12/01/2006
Last updated
12/26/2015
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