MEDICARE: DALTON MAPLES JR. PA-C

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
1	363A00000X	Physician Assistant	PA825	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932139748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALTON MAPLES JR. PA-C

Provider Business Mailing Address
First Line	:	1853 OCONNELL BLVD
Second Line	:	BUILDING 1042
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4055
Country	:	US
Telephone Number	:	719-526-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1853 OCONNELL BLVD
Second Line	:	BUILDING 1042
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4055
Country	:	US
Telephone Number	:	719-526-9408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	10/25/2012

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