Provider Demographics
NPI:1790827517
Name:WALTON, JARVIS D (MD)
Entity Type:Individual
Prefix:DR
First Name:JARVIS
Middle Name:D
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 1:175 RIVER BRIDGE LN
Mailing Address - Street 2:202
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-7906
Mailing Address - Country:US
Mailing Address - Phone:901-521-3006
Mailing Address - Fax:
Practice Address - Street 1:175 RIVER BRIDGE LN
Practice Address - Street 2:202
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-7906
Practice Address - Country:US
Practice Address - Phone:901-521-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine