Provider Demographics
NPI:1952388704
Name:DALTON, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DALTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4415 S HARVARD AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2618
Mailing Address - Country:US
Mailing Address - Phone:539-202-1585
Mailing Address - Fax:539-202-1588
Practice Address - Street 1:4415 S HARVARD AVE STE 209
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2618
Practice Address - Country:US
Practice Address - Phone:539-202-1585
Practice Address - Fax:539-202-1588
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI05291Medicare UPIN
OK243416700Medicare PIN