Provider Demographics
NPI:1184633208
Name:WALTER, JAMES CLEO II (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLEO
Last Name:WALTER
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:SUITE 130, LB 11
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4418
Mailing Address - Country:US
Mailing Address - Phone:214-750-1207
Mailing Address - Fax:214-739-5029
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:STE 240
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-378-1438
Practice Address - Fax:972-378-1432
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK0395207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037261702Medicaid
TX037261703Medicaid
TX8210J3OtherBCBS
TX200044199Medicare PIN
G50540Medicare UPIN
TX037261703Medicaid
TX037261702Medicaid
TX200041199Medicare PIN
TX200041198Medicare PIN
TX200044198Medicare PIN