Provider Demographics
NPI:1366447658
Name:WALTON, VICKIE A (MD INC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:A
Last Name:WALTON
Suffix:
Gender:F
Credentials:MD INC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1313 E HERNDON AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3306
Mailing Address - Country:US
Mailing Address - Phone:559-435-0311
Mailing Address - Fax:559-435-1708
Practice Address - Street 1:1313 E HERNDON AVE
Practice Address - Street 2:STE 205
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3306
Practice Address - Country:US
Practice Address - Phone:559-435-0311
Practice Address - Fax:559-435-1708
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG58237174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G582370Medicaid
CAD70724Medicare UPIN