Provider Demographics
NPI:1255495446
Name:DAN G. WALTERS, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAN G. WALTERS, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-327-8405
Mailing Address - Street 1:77564 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 408
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0484
Mailing Address - Country:US
Mailing Address - Phone:760-898-2968
Mailing Address - Fax:760-345-3888
Practice Address - Street 1:77564 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 408
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0484
Practice Address - Country:US
Practice Address - Phone:760-898-2968
Practice Address - Fax:760-345-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39049207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47686Medicare UPIN
CAZZZ07367ZMedicare PIN