Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | M9238 | TX |
NPI | 1497725576 |
---|---|
Provider Name | Dr. Scott Ryan Dalton |
First Address | Lackland Afb, TX 78236 |
Second Address | Lackland Afb, TX 78236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1497725576 | MILITARY (01) | |
400786601 | (05) | TX |
400786602 | CSHCN (01) | TX |