Provider Demographics
NPI:1497905566
Name:WALTON, MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:WALTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W 100 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5881
Mailing Address - Country:US
Mailing Address - Phone:801-798-7301
Mailing Address - Fax:801-798-8513
Practice Address - Street 1:336 W 100 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5881
Practice Address - Country:US
Practice Address - Phone:801-798-7301
Practice Address - Fax:801-798-8513
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15463207Q00000X
MO2018043154207Q00000X
LA311397207Q00000X
TXR9884207Q00000X
ARE-11862207Q00000X
UT5234046-1204207Q00000X
OK6563207Q00000X
CA20A16954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5234046-1204OtherUTAH STATE LICENSE
PAOS014514OtherMEDICAL LICENSE