Provider Demographics
NPI:1205865722
Name:RIOS, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:RIOS
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 1:2601 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6508
Mailing Address - Country:US
Mailing Address - Phone:972-272-1632
Mailing Address - Fax:972-272-5220
Practice Address - Street 1:2601 FOREST LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6508
Practice Address - Country:US
Practice Address - Phone:972-272-1632
Practice Address - Fax:972-272-5220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157971601Medicaid
TX157971602Medicaid
TX0020JUOtherBLUE CROSS BLUE SHIELD
TXH80420Medicare UPIN
TX0020JUOtherBLUE CROSS BLUE SHIELD