Healthcare Provider Details

I. General information

NPI: 1427322684
Provider Name (Legal Business Name): PETER LINCOLN DALTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

PO BOX 713350
CHICAGO IL
60677-1392
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-6000
  • Fax:
Mailing address:
  • Phone: 502-558-9490
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO2197
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number20A17546
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number04941
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: