Provider Demographics
NPI:1073667275
Name:WALTON, MARK STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:WALTON
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 1:5370 COLLEGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1935
Mailing Address - Country:US
Mailing Address - Phone:913-599-4800
Mailing Address - Fax:913-599-2992
Practice Address - Street 1:5370 COLLEGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1891
Practice Address - Country:US
Practice Address - Phone:913-599-4800
Practice Address - Fax:913-599-2992
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD105370207YX0007X
KS04-24974207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100161420AMedicaid
1008080OtherUNITEDHEALTH CARE
MO21144013OtherBCBS OF KANSAS CITY
KS101450OtherBCBS OF KANSAS
MOE526437AMedicare ID - Type UnspecifiedKANSAS CITY, MO
KS100161420AMedicaid
KS101450OtherBCBS OF KANSAS
1008080OtherUNITEDHEALTH CARE
MOE526437BMedicare ID - Type UnspecifiedBELTON, MO