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NPI Code Detail

MEDICARE: BETTY DERRELLENE WALTON MD

MEDICARE: BETTY DERRELLENE WALTON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianG23506CA
2207P00000XEmergency Medicine PhysicianG23506CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386691715
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY DERRELLENE WALTON MD
Provider Business Mailing Address
First Line : 323 E MATILIJA ST
Second Line : #110
City : OJAI
State : CA
Zip : 93023-2740
Country : US
Telephone Number : 805-208-5420
Fax Number :
Provider Business Practice Location Address
First Line : 3800 JANES RD
Second Line :
City : ARCATA
State : CA
Zip : 95521-4742
Country : US
Telephone Number : 925-225-5837
Fax Number : 925-225-5838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 04/10/2019

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Directions to “ BETTY DERRELLENE WALTON MD” Practice Location

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