Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.090761 | OH |
NPI | 1316157191 |
---|---|
Provider Name | Dr. John Brandon Walters |
First Address | Cleveland, OH 44110-2602 |
Second Address | Westlake, OH 44145-5270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WA4264281 | (02) | OH |