Healthcare Provider Details

I. General information

NPI: 1750316949
Provider Name (Legal Business Name): GREGORY F WALTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD 2ND FLOOR
EDMOND OK
73013-3023
US

IV. Provider business mailing address

1800 RENAISSANCE BLVD 2ND FLOOR
EDMOND OK
73013-3023
US

V. Phone/Fax

Practice location:
  • Phone: 405-359-2473
  • Fax:
Mailing address:
  • Phone: 405-359-2475
  • Fax: 405-341-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20136
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: