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General NPI Number Information
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NPI Number | 1528150737
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY PHYSICIANS, PLLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21017 NYS RT 12F
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City | WATERTOWN
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State | NY
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Zip | 13601-1078
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Country | US
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Telephone | 315-782-1990
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Fax | 315-782-0347
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Provider Business Mailing Address
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Address Line | 21017 NYS RT 12F
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City | WATERTOWN
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State | NY
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Zip | 13601-1078
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Country | US
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Telephone | 315-782-1990
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Fax | 315-782-0347
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | WALTER AUGUST MINAERT JR.
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Credential | MD
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Telephone | 315-782-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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