Provider Demographics
NPI:1568925774
Name:DALTON RYBA D.P.M., P.A.
Entity Type:Organization
Organization Name:DALTON RYBA D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RYBA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:308-380-8410
Mailing Address - Street 1:1804 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1403
Mailing Address - Country:US
Mailing Address - Phone:308-380-8410
Mailing Address - Fax:
Practice Address - Street 1:215 OLD HIGHWAY 1187
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0281
Practice Address - Country:US
Practice Address - Phone:817-926-2663
Practice Address - Fax:817-293-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty