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NPI Code Detail

MEDICARE: STEPHEN LEWIS DALTON M.D.

MEDICARE: STEPHEN LEWIS DALTON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianA62214CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00429886OTHERCARAILROAD MEDICARE

General Provider Information

NPI Number : 1053318824
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN LEWIS DALTON M.D.
Provider Business Mailing Address
First Line : 400 PROFESSIONAL CENTER DR
Second Line : SUITE 414
City : NOVATO
State : CA
Zip : 94947-4367
Country : US
Telephone Number : 415-892-0754
Fax Number : 415-897-3204
Provider Business Practice Location Address
First Line : 400 PROFESSIONAL CENTER DR
Second Line : SUITE 414
City : NOVATO
State : CA
Zip : 94947-4367
Country : US
Telephone Number : 415-892-0754
Fax Number : 415-897-3204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 10/09/2008

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