MEDICARE: DELMAR KENT LAYTON MD

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	207P00000X	Emergency Medicine Physician	12279	AZ
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	12279	AZ
3	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	12279	AZ

General Provider Information

NPI Number	:	1184687121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELMAR KENT LAYTON MD

Provider Business Mailing Address
First Line	:	PO BOX 64568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-4568
Country	:	US
Telephone Number	:	602-839-6968
Fax Number	:	602-839-4144

Provider Business Practice Location Address
First Line	:	2050 W SOUTHERN AVE
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85120-7305
Country	:	US
Telephone Number	:	602-839-6968
Fax Number	:	602-839-4144

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	12/04/2015

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