1710957725 NPI number — ALAN JAMES WALTON MD

Table of content: ALAN JAMES WALTON MD (NPI 1710957725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710957725 NPI number — ALAN JAMES WALTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTON
Provider First Name:
ALAN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710957725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 975
Provider Second Line Business Mailing Address:
2200 NORTH KIMBALL, SUITE 700
Provider Business Mailing Address City Name:
MITCHELL
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57301-0975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-996-1159
Provider Business Mailing Address Fax Number:
605-996-2978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER DAM
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53916-2437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-887-1153
Provider Business Practice Location Address Fax Number:
920-887-1044
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  27838 - 020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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