Provider Demographics
NPI:1053590737
Name:DENNIS W DEL PAINE MD INC
Entity type:Organization
Organization Name:DENNIS W DEL PAINE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-951-4100
Mailing Address - Street 1:5309 CARRINGTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3516
Mailing Address - Country:US
Mailing Address - Phone:209-951-4100
Mailing Address - Fax:209-951-2324
Practice Address - Street 1:5309 CARRINGTON CIRCLE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3516
Practice Address - Country:US
Practice Address - Phone:209-951-4100
Practice Address - Fax:209-951-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37345207K00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47047Medicare UPIN
CA00G373450Medicare PIN