Provider Demographics
NPI:1518062587
Name:WALTON, PATRICK JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 DANAS POINT DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8290
Mailing Address - Country:US
Mailing Address - Phone:406-459-5849
Mailing Address - Fax:
Practice Address - Street 1:6330 DANAS POINT DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-8290
Practice Address - Country:US
Practice Address - Phone:406-459-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0108277Medicaid
MT010001702Medicare ID - Type Unspecified
MTE65124Medicare UPIN