Provider Demographics
NPI:1285460980
Name:PARKE, DALTON CURTIS (PA)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:CURTIS
Last Name:PARKE
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:3332 SANTE FE COURT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:801-310-5930
Mailing Address - Fax:
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-327-4796
Practice Address - Fax:505-443-8335
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-10-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant