Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0102202333 | VA |
N | 207Q00000X | Family Doctor | 0102202333 | VA |
NPI | 1245498062 |
---|---|
Provider Name | Joshua Heath Dalton |
First Address | Big Stone Gap, VA 24219 |
Second Address | Big Stone Gap, VA 24219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 08/09/2011 |