Individual
MR. DALE LOWELL SYVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1825 MAIN STREET, SUSANVILLE, CA 96130
(530) 252-4115
(530) 252-4117
Mailing address
1825 MAIN ST, SUSANVILLE, CA 96130-4518
(530) 252-4115
(530) 252-4117
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G87246
CA
208C00000X
Colon & Rectal Surgery Physician
G87246
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G6872460
—
CA
Enumeration date
11/09/2006
Last updated
08/08/2011
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