Healthcare Provider Details

I. General information

NPI: 1104621648
Provider Name (Legal Business Name): JOHN R WALTERS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N A ST
OXNARD CA
93030-4309
US

IV. Provider business mailing address

703 N A ST
OXNARD CA
93030-4309
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-2340
  • Fax: 805-485-1429
Mailing address:
  • Phone: 805-485-2340
  • Fax: 805-485-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN RAMSAY WALTERS
Title or Position: OWNER
Credential: MD
Phone: 805-485-2340