Provider Demographics
NPI:1063462877
Name:WALTON, JAMES W (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
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 1:4001A WORTH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1608
Mailing Address - Country:US
Mailing Address - Phone:214-828-1745
Mailing Address - Fax:214-828-1734
Practice Address - Street 1:4001A WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1608
Practice Address - Country:US
Practice Address - Phone:214-828-1745
Practice Address - Fax:214-828-1734
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133950904Medicaid
TX110121044OtherRR MEDICARE
TX84Y710Medicare ID - Type Unspecified
TXE52124Medicare UPIN