Provider Demographics
NPI:1043401607
Name:WALTON, JESSE ANDREW
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ANDREW
Last Name:WALTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 OLD GENTILLY RD
Mailing Address - Street 2:MEDICAL DIVISION
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2218
Mailing Address - Country:US
Mailing Address - Phone:504-253-6501
Mailing Address - Fax:504-253-6525
Practice Address - Street 1:13800 OLD GENTILLY RD
Practice Address - Street 2:MEDICAL DIVISION
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2218
Practice Address - Country:US
Practice Address - Phone:504-253-6501
Practice Address - Fax:504-253-6525
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider