Walton, Michael Glen
Walton, Michael Glen is an individual health care provider with primary practice located at 1453 E Bert Koun Loop Ste 112 , Shreveport LA 71105-6810. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Walton, Michael Glen can be contacted via phone (318) 798-9400.Contact Information
Primary practice address
1453 E Bert Koun Loop Ste 112
Shreveport LA 71105-6810
Phone: (318) 798-9400
Fax: (318) 795-4656
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | MD.021647 | Louisiana |
Profile Details
| NPI number | 1255321881 |
|---|---|
| LBN Legal business name | Walton, Michael Glen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 25th, 2005 |
| Last updated | Dec 9th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255321881 | NPPES |
| Arkansas | MEDICAID | 132755001 | |
| Arkansas | Other | 060043277 | |
| Arkansas | MEDICAID | 059411101 | |
| Arkansas | MEDICAID | 1659525 |
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