Provider Demographics
NPI:1407833395
Name:WALTON, CHARLES B (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:B
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:10001 S EASTERN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3908
Mailing Address - Country:US
Mailing Address - Phone:702-914-2420
Mailing Address - Fax:702-914-6653
Practice Address - Street 1:10001 S EASTERN AVE STE 310
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3908
Practice Address - Country:US
Practice Address - Phone:702-914-2420
Practice Address - Fax:702-914-6653
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002414Medicaid
NV002002414Medicaid
F28017Medicare UPIN