Healthcare Provider Details

I. General information

NPI: 1093711160
Provider Name (Legal Business Name): WALTER B GUTHRIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 W PARK DR
MORGANTON NC
28655-4218
US

IV. Provider business mailing address

244 W PARK DR
MORGANTON NC
28655-4218
US

V. Phone/Fax

Practice location:
  • Phone: 828-260-5347
  • Fax:
Mailing address:
  • Phone: 828-260-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2012-01677
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: