Provider Demographics
NPI:1407879901
Name:FLETSCHER, WALTER L (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:L
Last Name:FLETSCHER
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 1:2510 AIRPARK DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2462
Mailing Address - Country:US
Mailing Address - Phone:530-241-9966
Mailing Address - Fax:530-241-9783
Practice Address - Street 1:2510 AIRPARK DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2462
Practice Address - Country:US
Practice Address - Phone:530-241-9966
Practice Address - Fax:530-241-9783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486440Medicaid
CA00G486440Medicare ID - Type Unspecified
CAA51129Medicare UPIN