Provider Demographics
NPI:1154642908
Name:ROBERT B. WALTON, M.D. PA
Entity Type:Organization
Organization Name:ROBERT B. WALTON, M.D. PA
Other - Org Name:ROBERT B. WALTON, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:870-793-2223
Mailing Address - Street 1:12 HOSPITAL CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7310
Mailing Address - Country:US
Mailing Address - Phone:870-793-2223
Mailing Address - Fax:870-793-6513
Practice Address - Street 1:12 HOSPITAL CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7310
Practice Address - Country:US
Practice Address - Phone:870-793-2223
Practice Address - Fax:870-793-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110003778OtherRAILROAD MEDICARE
AR102753001Medicaid
AR102753001Medicaid
D049871Medicare PIN