Provider Demographics
NPI:1053409888
Name:DALTON, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:DALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:731 MARTIN RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2703
Practice Address - Country:US
Practice Address - Phone:817-514-0346
Practice Address - Fax:817-514-0885
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126950806Medicaid
TX148395OtherPHCS PIN
TX126950807OtherCSHCN
TX1618346OtherCIGNA PIN
TXDALJC14989OtherCCHIP PIN
TX86W430OtherBCBSTX IND PIN
TX4019308OtherAETNA PIN
TX916655OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
TX1640343OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TXB126465Medicare PIN
TX126950807OtherCSHCN