Provider Demographics
NPI:1972077477
Name:SEXTON, DALTON LEE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:DALTON
Middle Name:LEE
Last Name:SEXTON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 E 750 S
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-9775
Mailing Address - Country:US
Mailing Address - Phone:812-243-3932
Mailing Address - Fax:
Practice Address - Street 1:10755 163RD PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8861
Practice Address - Country:US
Practice Address - Phone:812-243-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant