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Individual

DALTON CHASE GIFFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 323-5000
Mailing address
3209 KEITHSHIRE WAY, LEXINGTON, KY 40503-3481
(606) 316-3040

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC964
KY
363A00000X
Physician Assistant
363AM0700X
Medical Physician Assistant
TC964
KY
363AS0400X
Surgical Physician Assistant
TC964
KY

Other

Enumeration date
06/23/2020
Last updated
09/10/2020
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