Provider Demographics
NPI:1194851063
Name:EGERTON, WALTER EUGENE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EUGENE
Last Name:EGERTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:175 CAMPUS LAKES CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1713
Mailing Address - Country:US
Mailing Address - Phone:410-734-0211
Mailing Address - Fax:410-734-6610
Practice Address - Street 1:1303 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-450-7098
Practice Address - Fax:559-450-4238
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2018-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC25492208000000X
DCMD034443208000000X
NY1808462080A0000X
MDD00590172080A0000X
CAC1469782080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics