MEDICARE: DR. BRIAN J WALTERS 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
1	207Q00000X	Family Medicine Physician	R1880	KY
2	207Q00000X	Family Medicine Physician	43598	KY

General Provider Information

NPI Number	:	1750511929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN J WALTERS MD

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-301-7210
Fax Number	:	859-301-7216

Provider Business Practice Location Address
First Line	:	1808 BRISTOW DRIVE
Second Line	:	PRIMARY CARE-UNION BRISTOW DRIVE
City	:	UNION
State	:	KY
Zip	:	41091-3513
Country	:	US
Telephone Number	:	859-301-7210
Fax Number	:	859-301-7216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	03/30/2021

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