Provider Demographics
NPI:1497720817
Name:MARK RAY DALTON MD PA
Entity Type:Organization
Organization Name:MARK RAY DALTON MD PA
Other - Org Name:AUSTIN ANKLE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-225-6335
Mailing Address - Street 1:PO BOX 268969
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8969
Mailing Address - Country:US
Mailing Address - Phone:512-225-6335
Mailing Address - Fax:512-225-6336
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:STE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1166
Practice Address - Country:US
Practice Address - Phone:512-225-6335
Practice Address - Fax:512-225-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0044PWOtherBCBS OF TEXAS GROUP #
TX162588101Medicaid
TX0044PWOtherBCBS OF TEXAS GROUP #
TX00963VMedicare PIN