Provider Demographics
NPI:1770567976
Name:WALTON, BRIAN L (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
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 1:321 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7919
Mailing Address - Country:US
Mailing Address - Phone:254-235-9355
Mailing Address - Fax:254-235-0904
Practice Address - Street 1:321 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-235-9355
Practice Address - Fax:254-235-0904
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3179207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165999705Medicaid
TX165999701Medicaid
TX165999702Medicaid
TX165999704Medicaid
TX8L10361Medicare PIN
I07638Medicare UPIN
TX165999704Medicaid
TX165999702Medicaid
TX8L9286Medicare PIN
TX8L11444Medicare PIN