Individual
DALE R MAYROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10590 N MERIDIAN ST, INDIANAPOLIS, IN 46290-1028
(317) 338-6666
Mailing address
8840 COMMERCE PARK PL STE E, INDIANAPOLIS, IN 46268-3129
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01056506A
IN
208M00000X
Hospitalist Physician
Primary
01056506A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200406550
—
IN
Enumeration date
03/10/2006
Last updated
11/03/2014
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