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General NPI Number Information
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NPI Number | 1710378955
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Entity Type | Individual
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Provider Name | COURT CARROLL WALTERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 33 N SKINNER RD
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City | ALLENSPARK
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State | CO
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Zip | 80510-0523
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Country | US
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Telephone | 303-747-2461
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 523
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City | ALLENSPARK
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State | CO
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Zip | 80510-0523
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Country | US
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Telephone | 303-747-2461
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0054782
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License Number State | CO
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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 | 29106
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9701191
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License Number State | NC
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