Healthcare Provider Details

I. General information

NPI: 1033796867
Provider Name (Legal Business Name): ROBERT SCOTT DAULTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 10/24/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2008
CINCINNATI OH
45229
US

IV. Provider business mailing address

2742 HYDE PARK AVE APT 2
CINCINNATI OH
45209
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4200
  • Fax:
Mailing address:
  • Phone: 614-905-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.149991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: