Basic Information
| Provider Information | |||||||||
| NPI: | 1053409888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 731 MARTIN RD | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760542703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175140346 | ||||||||
| FaxNumber: | 8175140885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D9410 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 126950806 | 05 | TX | MEDICAID | 148395 | 01 | TX | PHCS PIN | OTHER | 126950807 | 01 | TX | CSHCN | OTHER | 1618346 | 01 | TX | CIGNA PIN | OTHER | DALJC14989 | 01 | TX | CCHIP PIN | OTHER | 86W430 | 01 | TX | BCBSTX IND PIN | OTHER | 4019308 | 01 | TX | AETNA PIN | OTHER | 916655 | 01 | TX | UHC PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 1640343 | 01 | TX | FIRSTHEALTH PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER |