Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A46739 | CA |
Y | 111NI0900X | Internist | A46739 | CA |
N | 207RC0200X | Critical Care Medicine | A46739 | CA |
N | 207RP1001X | Pulmonary Disease | A46739 | CA |
NPI | 1013907203 |
---|---|
Provider Name | John R Walters |
First Address | Oxnard, CA 93030-4309 |
Second Address | Oxnard, CA 93030-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 05/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W1153 | (02) | |
ZZZ80185Z | (05) | CA |