Provider Demographics
NPI:1801079488
Name:MACKAY, DALTON J (MD)
Entity type:Individual
Prefix:DR
First Name:DALTON
Middle Name:J
Last Name:MACKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DALTON
Other - Middle Name:J
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 TOPEKA WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3116
Mailing Address - Country:US
Mailing Address - Phone:303-728-9661
Mailing Address - Fax:303-728-9786
Practice Address - Street 1:651 TOPEKA WAY STE 600
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3116
Practice Address - Country:US
Practice Address - Phone:303-728-9661
Practice Address - Fax:303-728-9786
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25129207Q00000X
CO48378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91584078Medicaid
COP01146749Medicare PIN
COCOA109438Medicare PIN