Provider Demographics
NPI:1427280007
Name:WALTON, BENJAMIN FLOYD IV (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FLOYD
Last Name:WALTON
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 2222
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-408-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206787207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAG3353973-W2984OtherDEA