Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25492 | NC |
N | 208000000X | Pediatrician | MD034443 | DC |
N | 2080A0000X | Adolescent Medicine | 180846 | NY |
Y | 2080A0000X | Adolescent Medicine | C146978 | CA |
N | 2080A0000X | Adolescent Medicine | D0059017 | MD |
NPI | 1194851063 |
---|---|
Provider Name | Dr. Walter Eugene Egerton III |
First Address | Bel Air, MD 21015-1713 |
Second Address | Fresno, CA 93720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 21/06/2018 |