Provider Demographics
NPI:1205809043
Name:DALTON, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:DALTON
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:PO BOX 5500
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75712-5500
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:214 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8131
Practice Address - Country:US
Practice Address - Phone:903-535-9041
Practice Address - Fax:903-533-0726
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8188207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138372112Medicaid
TX138372101Medicaid
TX85V178OtherBCBS
TXTXB134275Medicare Oscar/Certification
TX138372101Medicaid
TXP00966735Medicare PIN
TX85V178OtherBCBS