Provider Demographics
NPI:1164478194
Name:DALLEY, ALBERT SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:SEAN
Last Name:DALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7012
Mailing Address - Country:US
Mailing Address - Phone:817-558-3937
Mailing Address - Fax:817-641-6424
Practice Address - Street 1:808 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7012
Practice Address - Country:US
Practice Address - Phone:817-558-3937
Practice Address - Fax:817-641-6424
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158206601Medicaid
TX158206603Medicaid
TX8J5410OtherBLUE CROSS BLUE SHIELD
P00042091OtherRAILROAD MEDICARE
P00042091OtherRAILROAD MEDICARE
TXH83847Medicare UPIN