| Leo B. Dalton, D.O. | |
|
9545 Bay Pines Blvd St Petersburg FL 33708-3754 | |
| (727) 393-8715 | |
| (727) 393-8717 |
| Full Name | Leo B. Dalton, D.O. |
|---|---|
| Speciality | Family Medicine |
| Location | 9545 Bay Pines Blvd, St Petersburg, Florida |
| Authorized Official Name and Position | Leo Bernard Dalton (OWNER) |
| Authorized Official Contact | 7273938715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leo B. Dalton, D.O. 9545 Bay Pines Blvd St Petersburg FL 33708-3754 Ph: (727) 393-8715 | Leo B. Dalton, D.O. 9545 Bay Pines Blvd St Petersburg FL 33708-3754 Ph: (727) 393-8715 |
| NPI Number | 1114236940 |
|---|---|
| Provider Enumeration Date | 09/28/2010 |
| Last Update Date | 09/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114236940 | NPI | - | NPPES |
| 040070000 | Medicaid | FL | |
| OS3212 | Other | FL | STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS3212 (Florida) | Primary |
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