Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 0101054852 | VA |
NPI | 1346340676 |
---|---|
Provider Name | Dr. Walter Alfred Divers |
First Address | Lexington, KY 40504-2043 |
Second Address | Lexington, KY 40504-2043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |