Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | ME119120 | FL |
NPI | 1932288719 |
---|---|
Provider Name | Robert Lee Walton |
First Address | Chicago, IL 60611-1495 |
Second Address | Chicago, IL 60611-1495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 24/05/2017 |