Healthcare Provider Details

I. General information

NPI: 1053461319
Provider Name (Legal Business Name): CHRISTOPHER RONALD WALTERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W 27TH ST
LUMBERTON NC
28358-3019
US

IV. Provider business mailing address

517 TALL OAKS DR
DURHAM NC
27713-9358
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-6619
  • Fax:
Mailing address:
  • Phone: 919-274-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200401001
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: