Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | ME98284 | FL |
Y | 207WX0107X | Retina Specialist | ME98284 | FL |
NPI | 1023057395 |
---|---|
Provider Name | Dr. Kenneth T Wals |
First Address | Coral Gables, FL 33134 |
Second Address | Coral Gables, FL 33134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 25/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000171300 | (05) | FL |
AG798Z/ AG798Y | (02) | FL |