Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301069518 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301069518 | MI |
N | 208000000X | Pediatrician | 4301069518 | MI |
NPI | 1528143567 |
---|---|
Provider Name | Edward Allen Walton |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-0014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26710 | (02) | MI |