Provider Demographics
NPI:1235133737
Name:DALTON, EMILY LAMBERT (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LAMBERT
Last Name:DALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MIRAIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:2800 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4809
Practice Address - Country:US
Practice Address - Phone:707-445-8416
Practice Address - Fax:707-445-4182
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F600530Medicare UPIN
00G762901Medicare ID - Type Unspecified