Provider Demographics
NPI:1033142831
Name:DALTON, RACHAEL MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:MARIE
Last Name:DALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:MARIE
Other - Last Name:PAKUNPANYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8231 W BURROUGHS RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9764
Mailing Address - Country:US
Mailing Address - Phone:509-999-2239
Mailing Address - Fax:
Practice Address - Street 1:8231 W. BURROUGHS ROAD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-999-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26798207Q00000X
CAC142350207Q00000X
WAMD60641543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242941Medicaid
ORP00414448Medicare PIN
OR242941Medicaid
R135914Medicare PIN