Individual
ANTHONY RAY DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
851 LEONARD FULGHUM DR STE 100, MOUNT PLEASANT, SC 29464-3793
(888) 853-1529
Mailing address
1628 BALTUSROL LN, MOUNT PLEASANT, SC 29466-9005
(503) 828-6425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3734
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2008
PA LICENSE
ID
01
—
PA3734
PA LICENSE
SC
Enumeration date
09/23/2021
Last updated
09/23/2021
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