Provider Demographics
NPI:1366491631
Name:WALTERS, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:WALTERS
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 1:2040 HUTTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4526
Mailing Address - Country:US
Mailing Address - Phone:913-299-3700
Mailing Address - Fax:913-721-3316
Practice Address - Street 1:2040 HUTTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4566
Practice Address - Country:US
Practice Address - Phone:913-299-3700
Practice Address - Fax:913-299-3050
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100328810BMedicaid
KS100216770CMedicaid
KSF204693Medicare PIN
KS100216770CMedicaid
KSF200000Medicare PIN