Provider Demographics
NPI:1861018210
Name:LOHSANDT, DALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DALTON
Middle Name:
Last Name:LOHSANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1243
Mailing Address - Country:US
Mailing Address - Phone:660-248-2217
Mailing Address - Fax:660-248-3450
Practice Address - Street 1:308 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1243
Practice Address - Country:US
Practice Address - Phone:660-248-2217
Practice Address - Fax:660-248-3450
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028860207Q00000X
MO2020015982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine