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General NPI Number Information
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NPI Number | 1477495414
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Entity Type | Individual
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Provider Name | CONLEY LEON WALTERS MEDICAL STUDENT
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Gender | Male
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 469-492-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 8329 PERSIMMON TREE RD
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City | BETHESDA
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State | MD
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Zip | 20817-2647
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Country | US
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Telephone | 469-492-8151
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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