Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11233 | TX |
NPI | 1003020058 |
---|---|
Provider Name | Dr. William Michael Walton |
First Address | Clyde, TX 79510-0481 |
Second Address | Clyde, TX 79510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |