Provider Demographics
NPI:1982726865
Name:DALTON, CATHERINE I (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:I
Last Name:DALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-729-1253
Mailing Address - Fax:360-729-3185
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:458-209-5093
Practice Address - Fax:458-209-5028
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMD168162208100000X
NE28637208100000X
MDD67970208100000X
MA247118208100000X
KY46021208100000X
ORMD168162208100000X
OK31458208100000X
AR390200000X
RIMD17018208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500682189Medicaid
ORR179215Medicare PIN
MDP00752406OtherR/R MEDICARE INDIVIDUAL #
MD132221ZAVKMedicare PIN
KYP01189081OtherMEDICARE RAILROAD
MDCA8374OtherR/R MEDICARE GROUP#