Basic Information
| Provider Information | |||||||||
| NPI: | 1982726865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALTON | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | I. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986839324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291253 | ||||||||
| FaxNumber: | 3607293185 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 HILYARD ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4582095093 | ||||||||
| FaxNumber: | 4582095028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD168162 | OK | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 28637 | NE | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | D67970 | MD | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 247118 | MA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 46021 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | MD168162 | OR | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 31458 | OK | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 390200000X | AR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208100000X | MD17018 | RI | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 500682189 | 05 | OR | MEDICAID |