Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | F3657 | TX |
NPI | 1023056165 |
---|---|
Provider Name | Dr. Michael Capwell Walter |
First Address | Fort Worth, TX 76109-3559 |
Second Address | Fort Worth, TX 76109-3559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 04/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132237202 | (05) | TX |
132237207 | (05) | TX |
132237208 | (05) | TX |
132237209 | (05) | TX |
C23141 | (02) | TX |