Individual
LESLIE W DALTON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 W BEN WHITE BLVD, AUSTIN, TX 78704-6903
(512) 448-7100
Mailing address
PO BOX 164106, AUSTIN, TX 78716-4106
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
H3997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129107203
—
TX
05
—
129107204
—
TX
05
—
129107206
—
TX
05
—
129107207
—
TX
05
—
129107208
—
TX
Enumeration date
05/26/2005
Last updated
04/23/2009
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