Provider Demographics
NPI:1073559365
Name:WALTON, RHONDA LEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:LEN
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 1:801 N PEAK ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1346
Mailing Address - Country:US
Mailing Address - Phone:214-821-8644
Mailing Address - Fax:214-827-3282
Practice Address - Street 1:801 N PEAK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1346
Practice Address - Country:US
Practice Address - Phone:214-821-8644
Practice Address - Fax:214-827-3282
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114611005Medicaid
TXTXB112681Medicare PIN
TXE51612Medicare UPIN