Larry R Walton

Primary specialty

SpecialistTaxonomy code 174400000X

License

039773 Issued in MI

Practice address

1220 West Milham Ave
Portage, MI 49024-1206

Phone

(269) 382-9900

Fax

(269) 382-0700

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1063440311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 WEST MILHAM AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490241206",
            "telephone_number": "269-382-9900",
            "fax_number": "269-382-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 WEST MILHAM AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490241206",
            "telephone_number": "269-382-9900",
            "fax_number": "269-382-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTON",
        "first_name": "LARRY",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MI",
            "license": "039773",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "039773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "039279",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4079644",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christy Walker, M.A., L.P.C.
• Bonnie Merritt Wallace, PA-C
• Brian Walny
• Joseph Bruce Walters, M.S. P.T
• Leah Welch Walters, P.T
• Stephani Walton
• Chuandi Wang, D.D.S.
• Paul W Wang, M.D.
• Xue Wang, M.D.
• Dashaya Ward

• Specialist in Portage, MI
• Providers in Portage, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.