Provider Demographics
NPI:1891738209
Name:WALTON, GILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
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 1:112 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2011
Mailing Address - Country:US
Mailing Address - Phone:626-568-0946
Mailing Address - Fax:
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:405
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-358-0269
Practice Address - Fax:626-301-0786
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92274Medicare UPIN