| Doctor Name: | DALE FOSSATI |
| NPI Number: | 1023121118 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | OR PA00125 |
| Business Practice Address: | 9900 Se Sunnyside Rd Clackamas, OR - 970159777 |
| Business Phone Number: | 5035718240 |
| Business Fax Number: | |
| Mailing Address: | 9900 Se Sunnyside Rd, CLACKAMAS |
| State: | OR |
| Postal Code: | 970159777 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 07/14/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | OR PA00125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |