Provider Demographics
NPI:1235271693
Name:WALTON, KIMBERLY R (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:WALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 CHALAN SAN ANTONIO
Mailing Address - Street 2:#271
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3602
Mailing Address - Country:US
Mailing Address - Phone:671-747-8569
Mailing Address - Fax:671-646-8569
Practice Address - Street 1:425 CHALAN SAN ANTONIO
Practice Address - Street 2:#271
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3602
Practice Address - Country:US
Practice Address - Phone:671-747-8569
Practice Address - Fax:671-646-8569
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA80933207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A809330Medicaid
CAH04638Medicare UPIN
CAA80933Medicare PIN