Healthcare Provider Details

I. General information

NPI: 1013970359
Provider Name (Legal Business Name): ARTHUR L WALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDIATRIC EXTENDED CARE CLINIC MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-0001
US

IV. Provider business mailing address

4614 77TH AVE NW
GIG HARBOR WA
98335-6532
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00043050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: