Provider Demographics
NPI:1811950694
Name:DALTON, TIMOTHY J (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S 70TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4293
Mailing Address - Country:US
Mailing Address - Phone:402-488-1400
Mailing Address - Fax:402-488-3879
Practice Address - Street 1:1101 S 70TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4293
Practice Address - Country:US
Practice Address - Phone:402-488-1400
Practice Address - Fax:402-488-3879
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE20868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301100Medicaid
NEP00212360OtherRAILROAD MEDICARE
NEP00212360OtherRAILROAD MEDICARE
NE47055301100Medicaid