MEDICARE: DALTON MARK ALLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1204821433	TX

General Provider Information

NPI Number	:	1154818821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALTON MARK ALLEN

Provider Business Mailing Address
First Line	:	2111 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4834
Country	:	US
Telephone Number	:	817-596-3700
Fax Number	:	888-284-8634

Provider Business Practice Location Address
First Line	:	2111 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4834
Country	:	US
Telephone Number	:	817-596-3700
Fax Number	:	888-284-8634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	05/01/2024

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Directions to “ DALTON MARK ALLEN ” Practice Location

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