Provider Demographics
NPI:1326035676
Name:MATTHEWS, WALTER MARK (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:MARK
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:208 W CASABLANCA CANNON AFB
Mailing Address - Street 2:BLDG 1400 27 MEDICAL GROUP
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5014
Mailing Address - Country:US
Mailing Address - Phone:505-784-6608
Mailing Address - Fax:505-784-6028
Practice Address - Street 1:208 W CASABLANCA CANNON AFB
Practice Address - Street 2:BLDG 1400 27 MEDICAL GROUP
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:505-784-6608
Practice Address - Fax:505-784-6028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXK27502083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN