Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 3627 | AR |
Y | 213EG0000X | General Practice | 3627 | AR |
NPI | 1003021692 |
---|---|
Provider Name | Dr. Gary Dalton |
First Address | Dermott, AR 71638-0509 |
Second Address | Dermott, AR 71638-2127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152991631 | (05) | AR |