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General NPI Number Information
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NPI Number | 1497117675
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Entity Type | Individual
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Provider Name | JAMES WALSTON
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Gender | Male
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 2211 NE 139TH ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2742
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Country | US
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Telephone | 503-413-8407
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 9TH AVE SE
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City | ROCHESTER
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State | MN
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Zip | 55904-5478
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Country | US
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Telephone | 612-210-0829
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 65708
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD213522
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License Number State | OR
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