Provider Demographics
NPI:1083907885
Name:MARK WALTON, D.O., P.C.
Entity Type:Organization
Organization Name:MARK WALTON, D.O., P.C.
Other - Org Name:MARK WALTON, D.O., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-597-4200
Mailing Address - Street 1:2141 N ACADEMY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1686
Mailing Address - Country:US
Mailing Address - Phone:719-597-4200
Mailing Address - Fax:719-597-4495
Practice Address - Street 1:2141 N ACADEMY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1686
Practice Address - Country:US
Practice Address - Phone:719-597-4200
Practice Address - Fax:719-597-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30145207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC1086-2OtherMEDICARE NUMBER