Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | MD0000014050 | TN |
Y | 207R00000X | Internist | 14050 | TN |
Y | 111NI0900X | Internist | 14050 | TN |
NPI | 1780774570 |
---|---|
Provider Name | Robert Edmund Walter |
First Address | Elizabethton, TN 37643-2848 |
Second Address | Elizabethton, TN 37643-2848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3195327 | (05) | TN |
3709285 | (02) | TN |