Provider Demographics
NPI:1891757522
Name:WALTON, RICHARD GREEN (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GREEN
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 1:32757 WHITE OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2563
Mailing Address - Country:US
Mailing Address - Phone:800-764-7297
Mailing Address - Fax:
Practice Address - Street 1:1000 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:586-493-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0566652085P0229X, 2085R0202X
MI51010092472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI009247OtherMI MEDICAL LICENSE
GA056665OtherGA MEDICAL LICENSE#
GA056665OtherGA MEDICAL LICENSE#
GA056665OtherGA MEDICAL LICENSE#