Provider Demographics
NPI:1538182142
Name:WALTON, WILLIAM WATKINS JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WATKINS
Last Name:WALTON
Suffix:JR
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4271
Mailing Address - Fax:859-258-4296
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4271
Practice Address - Fax:859-258-4296
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16015208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY36000818OtherMEDICAID ASC GRP
KY37903705OtherMEDICIAD LAB GRP
KY64160153Medicaid
GACB5773OtherRR MEDICARE GRP
KYASC1019OtherMEDICARE ASC GRP
KY4000501OtherMEDICARE LAB GRP
GACB5773OtherRR MEDICARE GRP
KY37903705OtherMEDICIAD LAB GRP