Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | K0395 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | K0395 | TX |
NPI | 1184633208 |
---|---|
Provider Name | Dr. James Cleo Walter II |
First Address | Dallas, TX 75231-4418 |
Second Address | Plano, TX 75093-8171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037261702 | (05) | TX |
037261703 | (05) | TX |
8210J3 | BCBS (01) | TX |
G50540 | (02) |