Provider Demographics
NPI:1063484350
Name:WALTON, MARTHA ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:WALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624
Mailing Address - Country:US
Mailing Address - Phone:830-997-6535
Mailing Address - Fax:830-997-9695
Practice Address - Street 1:755 S WASHINGTON
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624
Practice Address - Country:US
Practice Address - Phone:830-997-6535
Practice Address - Fax:830-997-9695
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1237207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M8010OtherBCBS TX
TX127710507Medicaid
TXC23151Medicare UPIN