Provider Demographics
NPI:1588613327
Name:WALTON, ROBERT E (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
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 1:20798 ARCH STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72065-9257
Mailing Address - Country:US
Mailing Address - Phone:501-888-8200
Mailing Address - Fax:501-888-8201
Practice Address - Street 1:20798 ARCH STREET PIKE
Practice Address - Street 2:
Practice Address - City:HENSLEY
Practice Address - State:AR
Practice Address - Zip Code:72065-9257
Practice Address - Country:US
Practice Address - Phone:501-888-8200
Practice Address - Fax:501-888-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155828003Medicaid
AR5M820Medicare ID - Type Unspecified
AR155828003Medicaid