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General NPI Number Information
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NPI Number | 1508966912
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Entity Type | Organization
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Legal Business Name | DAVID M. WALBORN MD PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 445 TREMONT ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-6150
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Country | US
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Telephone | 716-873-4406
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Fax | 716-873-4420
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Provider Business Mailing Address
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Address Line | 893 COLVIN BLVD
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City | KENMORE
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State | NY
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Zip | 14217-2423
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Country | US
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Telephone | 716-873-4406
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Fax | 716-873-4420
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MICHAEL WALBORN
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Credential | MD
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Telephone | 716-873-4406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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