Provider Demographics
NPI:1063455533
Name:TAYLOR, WALTON ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:WALTON
Middle Name:ALBERT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6833
Mailing Address - Country:US
Mailing Address - Phone:972-566-6115
Mailing Address - Fax:214-358-0186
Practice Address - Street 1:7777 FOREST LN STE C204
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6833
Practice Address - Country:US
Practice Address - Phone:972-566-6115
Practice Address - Fax:214-358-0186
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148752204Medicaid
TX148752203Medicaid
TX148752201Medicaid
TX148752202Medicaid
TX148752201Medicaid
TX8L1099Medicare PIN
TX8L1098Medicare PIN
8042J2Medicare ID - Type Unspecified
TX8L1097Medicare PIN