Healthcare Provider Details

I. General information

NPI: 1497905566
Provider Name (Legal Business Name): MATTHEW WALTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W 100 S
SPANISH FORK UT
84660-5881
US

IV. Provider business mailing address

336 W 100 S
SPANISH FORK UT
84660-5881
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7301
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15463
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018043154
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number311397
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9884
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-11862
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5234046-1204
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6563
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: