Provider Demographics
NPI:1285724948
Name:DALTON, ALYSSA M
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:M
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12229
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:99205-4805
Mailing Address - Country:US
Mailing Address - Phone:888-432-2088
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4805
Practice Address - Country:US
Practice Address - Phone:509-474-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA01060940A207P00000X
TXP2222207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DE452OtherBCBS-TX
TX297619301Medicaid
TX297619302Medicaid
WA8492449Medicaid
WA8492449Medicaid
TX8DE452OtherBCBS-TX
TXTXB166334Medicare PIN
WAG8868592Medicare PIN
WAI51442Medicare UPIN