Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 04-24974 | KS |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD105370 | MO |
NPI | 1073667275 |
---|---|
Provider Name | Dr. Mark Stephen Walton |
First Address | Overland Park, KS 66211-1935 |
Second Address | Overland Park, KS 66211-1891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100161420A | (05) | KS |
1008080 | UNITEDHEALTH CARE (01) | |
101450 | BCBS OF KANSAS (01) | KS |
21144013 | BCBS OF KANSAS CITY (01) | MO |
F88347 | (02) |