Provider Demographics
NPI:1427697549
Name:DALTONS FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:DALTONS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-362-0288
Mailing Address - Street 1:232 S OMAN RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2210
Mailing Address - Country:US
Mailing Address - Phone:720-362-0288
Mailing Address - Fax:
Practice Address - Street 1:651 TOPEKA WAY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3124
Practice Address - Country:US
Practice Address - Phone:720-362-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty