Healthcare Provider Details

I. General information

NPI: 1275633307
Provider Name (Legal Business Name): JEP P. DALTON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD SUITE 706
MONTGOMERY AL
36116-2001
US

IV. Provider business mailing address

2055 E SOUTH BLVD SUITE 706
MONTGOMERY AL
36116-2001
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-2900
  • Fax: 334-281-2637
Mailing address:
  • Phone: 334-288-2900
  • Fax: 334-281-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number7421
License Number StateAL

VIII. Authorized Official

Name: DR. JEP P DALTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 334-288-2900