Healthcare Provider Details

I. General information

NPI: 1639259294
Provider Name (Legal Business Name): NATHAN SCOTT WALTERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/20/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 GREENVILLE AVE STE 1180
DALLAS TX
75206-4130
US

IV. Provider business mailing address

7115 GREENVILLE AVE STE 230
DALLAS TX
75231-5104
US

V. Phone/Fax

Practice location:
  • Phone: 214-888-3888
  • Fax: 214-888-3889
Mailing address:
  • Phone: 214-888-3888
  • Fax: 214-888-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberL7595
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL7595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: