Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | K5499 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | K5499 | TX |
NPI | 1457324816 |
---|---|
Provider Name | Dr. Mark Ray Dalton |
First Address | Austin, TX 78759-4107 |
Second Address | Austin, TX 78759-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162846301 | (05) | TX |
8AJ073 | BCBS OF TEXAS INDIVIDUAL # (01) | TX |
H57569 | (02) | TX |