Provider Demographics
NPI:1942461561
Name:WALTON, BLAINE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:THOMAS
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 919229
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9229
Mailing Address - Country:US
Mailing Address - Phone:337-289-8944
Mailing Address - Fax:337-571-0030
Practice Address - Street 1:4212 W CONGRESS ST STE 3100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6771
Practice Address - Country:US
Practice Address - Phone:337-703-3201
Practice Address - Fax:337-703-3202
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2019-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAINTERNSHIP TRAINING207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery