Individual
DR. SCOTT RYAN DALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2200 BERGQUIST DR, SUITE 1, LACKLAND AFB, TX 78236
(415) 264-4136
Mailing address
2200 BERGQUIST DR, SUITE 1, LACKLAND AFB, TX 78236
(415) 264-4136
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
M9238
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
M9238
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497725576
MILITARY
—
05
—
400786601
—
TX
01
—
400786602
CSHCN
TX
Enumeration date
01/23/2006
Last updated
09/17/2019
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