Individual
DALTON MAPLES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1853 OCONNELL BLVD, BUILDING 1042, FORT CARSON, CO 80913-4055
(719) 526-9408
Mailing address
1853 OCONNELL BLVD, BUILDING 1042, FORT CARSON, CO 80913-4055
(719) 526-9408
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA825
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95005153
—
KY
Enumeration date
07/04/2006
Last updated
10/25/2012
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