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General NPI Number Information
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NPI Number | 1932156692
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Entity Type | Individual
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Provider Name | WALTER SCOTT EDWARDS MEDLIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1046 E 100 S SUITE A
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1520
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Country | US
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Telephone | 406-694-2487
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Fax | 801-746-2886
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Provider Business Mailing Address
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Address Line | 1046 E 100 S SUITE A
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1520
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Country | US
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Telephone | 406-694-2487
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Fax | 801-746-2886
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 47825-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00037282
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12854
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 8984752-1205
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License Number State | UT
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