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General NPI Number Information
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NPI Number | 1235276700
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Entity Type | Individual
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Provider Name | KEVIN CRAIG WALTERS MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 2213
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City | MERIDIAN
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State | ID
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Zip | 83642-6354
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Country | US
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Telephone | 208-706-5447
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Fax | 208-706-5448
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax | 503-375-5738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | MD25772
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | MD25772
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | M-15633
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License Number State | ID
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