Provider Demographics
NPI:1306829361
Name:WALTERS, GREGORY B (PAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PAC
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Other - Last Name:
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Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:MEDICAL CENTER CLINIC ORTHOPEDICS
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8300
Mailing Address - Fax:850-474-8654
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:WEST FLORIDA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8300
Practice Address - Fax:850-474-8654
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102186363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71196Medicare UPIN