Individual
DR. MARK D. DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 W MAGNOLIA AVE, STE 100, FORT WORTH, TX 76104-8517
(817) 870-7300
(817) 332-8372
Mailing address
6445 HARRIS PKWY, STE. 100, FORT WORTH, TX 76132-4138
(817) 361-6900
(817) 263-2918
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
D7000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099326302
—
TX
01
—
7564001
AETNA
—
01
—
85Y012
BCBS
—
Enumeration date
11/03/2005
Last updated
11/10/2010
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