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NPI Code Detail

MEDICARE: COURTNEY WALTERS M.D,

MEDICARE: COURTNEY WALTERS M.D,
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianL1589TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17417349OTHERTXAETNA
28G5671OTHERTXBCBS

General Provider Information

NPI Number : 1063495554
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY WALTERS M.D,
Provider Business Mailing Address
First Line : 3025 N TARRANT PKWY STE 150
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8633
Country : US
Telephone Number : 817-416-2229
Fax Number : 817-416-3667
Provider Business Practice Location Address
First Line : 3025 N TARRANT PKWY STE 150
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8633
Country : US
Telephone Number : 817-416-2229
Fax Number : 817-416-3667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 08/23/2021

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