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NPI Code Detail

MEDICARE: STEPHEN G DALTON DO

MEDICARE: STEPHEN G DALTON DO
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
1207Q00000XFamily Medicine PhysicianH7986TX

General Provider Information

NPI Number : 1396748554
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN G DALTON DO
Provider Business Mailing Address
First Line : 5219 CITY BANK PKWY
Second Line : STE 35
City : LUBBOCK
State : TX
Zip : 79407-3545
Country : US
Telephone Number : 806-785-2045
Fax Number : 806-722-2908
Provider Business Practice Location Address
First Line : 7501 QUAKER AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79424-3367
Country : US
Telephone Number : 806-792-8843
Fax Number : 806-799-0691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 01/17/2012

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