Provider Demographics
NPI:1275633307
Name:JEP P. DALTON, M.D., P.C.
Entity Type:Organization
Organization Name:JEP P. DALTON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEP
Authorized Official - Middle Name:P
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-288-2900
Mailing Address - Street 1:2055 E SOUTH BLVD
Mailing Address - Street 2:SUITE 706
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2001
Mailing Address - Country:US
Mailing Address - Phone:334-288-2900
Mailing Address - Fax:334-281-2637
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 706
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2001
Practice Address - Country:US
Practice Address - Phone:334-288-2900
Practice Address - Fax:334-281-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7421207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty