Provider Demographics
NPI:1558403683
Name:WILLIAM J. WALTON, M.D. P.A.
Entity Type:Organization
Organization Name:WILLIAM J. WALTON, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-349-3646
Mailing Address - Street 1:12200 PARK CENTRAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2107
Mailing Address - Country:US
Mailing Address - Phone:214-349-6576
Mailing Address - Fax:
Practice Address - Street 1:12200 PARK CENTRAL DR STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2107
Practice Address - Country:US
Practice Address - Phone:214-349-6576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4587898OtherCIGNA
TX0004227670OtherAETNA
TX8A9520OtherBLUE CROSS BLUE SHIELD
TX449460OtherUNITED HEALTHCARE
8B1502Medicare ID - Type Unspecified
TX8A9520OtherBLUE CROSS BLUE SHIELD