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General NPI Number Information
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NPI Number | 1487009734
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Entity Type | Individual
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Provider Name | CODY A WALTHALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2016
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 1109 E BROADWAY ST
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City | CUERO
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State | TX
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Zip | 77954
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Country | US
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Telephone | 361-275-2800
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Fax | 361-275-8791
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Provider Business Mailing Address
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Address Line | 1109 E BROADWAY ST
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City | CUERO
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State | TX
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Zip | 77954-2108
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Country | US
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Telephone | 361-275-2800
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Fax | 361-275-8791
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S2925
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-10831
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License Number State | AR
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Taxonomy #3
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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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