Individual
DOUGLAS DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2503 FOREST HILLS RD W STE B, WILSON, NC 27893-3392
(252) 991-0555
Mailing address
6702 TOWN CREEK RD, ELM CITY, NC 27822-8923
(406) 233-2500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09612
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000097653
BCBS PIN
MT
01
—
4309330
MDCD PIN
MT
Enumeration date
03/14/2006
Last updated
01/25/2022
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