Provider Demographics
NPI:1457355869
Name:WALTON, CHARLES WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WESLEY
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11286 N TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9595
Mailing Address - Country:US
Mailing Address - Phone:801-492-9162
Mailing Address - Fax:801-492-9163
Practice Address - Street 1:11286 N TAMARACK DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9595
Practice Address - Country:US
Practice Address - Phone:801-492-9162
Practice Address - Fax:801-492-9163
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT155451-1205207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine