Healthcare Provider Details

I. General information

NPI: 1043288210
Provider Name (Legal Business Name): DOUGLAS PAUL DALTON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 COBB CORNERS DRIVE
ROCKY MOUNT NC
27804
US

IV. Provider business mailing address

6702 TOWN CREEK RD
ELM CITY NC
27822-8923
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-4400
  • Fax: 252-364-4405
Mailing address:
  • Phone: 406-233-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09612
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: