Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 4128 | NC |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4128 | NC |
NPI | 1356364533 |
---|---|
Provider Name | James M Walter JR. |
First Address | Winston Salem, NC 27103-4012 |
Second Address | Winston Salem, NC 27103-4012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 29/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8998854 | (05) | NC |
T63807 | (02) |