Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 42113 | AZ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 42113 | AZ |
N | 2080P0203X | Pediatric Critical Care Doctor | MD16683 | DC |
NPI | 1194806026 |
---|---|
Provider Name | Heidi J Dalton |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 16/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027923400 | (05) | DC |
6729037 | (05) | VA |
774251700 | (05) | MD |
F15164 | (02) |