Provider Demographics
NPI:1619542099
Name:LAUT, DALTON (PA)
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:LAUT
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:7455 W WASHINGTON AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4356
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:702-258-3777
Practice Address - Street 1:1505 WIGWAM PKWY STE 330
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2022-12-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant