Healthcare Provider Details

I. General information

NPI: 1083907885
Provider Name (Legal Business Name): MARK WALTON, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 N ACADEMY CIR
COLORADO SPRINGS CO
80909-1686
US

IV. Provider business mailing address

2141 N ACADEMY CIR
COLORADO SPRINGS CO
80909-1686
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-4200
  • Fax: 719-597-4495
Mailing address:
  • Phone: 719-597-4200
  • Fax: 719-597-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30145
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number30145
License Number StateCO

VIII. Authorized Official

Name: MARK WILLIAM WALTON
Title or Position: OWNER/ PHYSICIAN
Credential: D.O.
Phone: 719-597-4200