Provider Demographics
NPI:1235276700
Name:WALTERS, KEVIN CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CRAIG
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2400 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1221
Mailing Address - Country:US
Mailing Address - Phone:503-361-4836
Mailing Address - Fax:503-375-5738
Practice Address - Street 1:2400 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1221
Practice Address - Country:US
Practice Address - Phone:503-314-9397
Practice Address - Fax:503-825-1595
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD257722083P0011X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine