Provider Demographics
NPI:1710988332
Name:DALTON, HAROLD LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LAWRENCE
Last Name:DALTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2226
Mailing Address - Country:US
Mailing Address - Phone:954-771-2551
Mailing Address - Fax:954-492-5266
Practice Address - Street 1:6000 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2226
Practice Address - Country:US
Practice Address - Phone:954-771-2551
Practice Address - Fax:954-492-5266
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7988208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51816Medicare ID - Type Unspecified
H25647Medicare UPIN