Provider Demographics
NPI:1043578834
Name:WALZ, DALLAS C (MD)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:C
Last Name:WALZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 E PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7408
Mailing Address - Country:US
Mailing Address - Phone:785-825-7251
Mailing Address - Fax:785-825-6887
Practice Address - Street 1:651 E PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7408
Practice Address - Country:US
Practice Address - Phone:785-825-7251
Practice Address - Fax:785-825-6887
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-36780OtherBOHA