Active NPI
Jeremy Scott Dalton
- Driver
- Duluth, MN
National Provider Identifier
1629612114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- D4354378224405
- Practice address
- 2910 W 3Rd St Apt 2
Duluth, MN 55806-3327 - Phone
- (218) 464-4292
- Fax
- (218) 464-1186
- NPI assigned
- Oct 29, 2019
- Last updated
- Oct 29, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | D4354378224405 | MN | Primary |
Addresses
Primary practice location
2910 W 3Rd St Apt 2
Duluth, MN 55806-3327
Mailing address
1517 N 56TH St
Superior, WI 54880-5826
Phone (218) 255-3379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4354378224405 | MN | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572307200000",
"number": "1629612114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1517 N 56TH ST",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548805826",
"telephone_number": "218-255-3379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2910 W 3RD ST APT 2",
"city": "DULUTH",
"state": "MN",
"postal_code": "558063327",
"telephone_number": "218-464-4292",
"fax_number": "218-464-1186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALTON",
"first_name": "JEREMY",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-29",
"last_updated": "2019-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "MN",
"license": "D4354378224405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.