Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D8188 | TX |
NPI | 1205809043 |
---|---|
Provider Name | Dr. David L Dalton |
First Address | Tyler, TX 75712-5500 |
Second Address | Tyler, TX 75702-8131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 03/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138372101 | (05) | TX |
138372112 | (05) | TX |
85V178 | BCBS (01) | TX |
B22103 | (02) |