1568408235 NPI number — STEPHEN WALTER MD

Table of content: STEPHEN WALTER MD (NPI 1568408235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568408235 NPI number — STEPHEN WALTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTER
Provider First Name:
STEPHEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568408235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75461-1307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-784-7210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 CLARKSVILLE ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-0220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-784-7210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  K4827 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HMO BLUE . This is a "8R9450" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153785403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: BCBS . This is a "8R9450" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200039610A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com