Healthcare Provider Details

I. General information

NPI: 1396748554
Provider Name (Legal Business Name): STEPHEN G DALTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 QUAKER AVE
LUBBOCK TX
79424-3367
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-8843
  • Fax: 806-799-0691
Mailing address:
  • Phone: 806-785-2045
  • Fax: 806-722-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH7986
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: