Healthcare Provider Details

I. General information

NPI: 1760725683
Provider Name (Legal Business Name): DANIEL ABRAHAM CARLTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PLAZA DR STE 225
ROSEVILLE CA
95661-3044
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-3399
  • Fax: 916-736-3350
Mailing address:
  • Phone: 916-736-3399
  • Fax: 916-233-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number2018010590
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA162302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: