Provider Demographics
NPI:1467743971
Name:WALTERS, NICK (MD, DTM&H, FAAFP)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD, DTM&H, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:BANGKOK ADVENTIST HOSPITAL
Mailing Address - Street 2:430 PITSANULOKE ROAD
Mailing Address - City:BANGKOK
Mailing Address - State:BANGKOK
Mailing Address - Zip Code:10300
Mailing Address - Country:TH
Mailing Address - Phone:662-282-1100
Mailing Address - Fax:662-280-0441
Practice Address - Street 1:BANGKOK ADVENTIST HOSPITAL
Practice Address - Street 2:430 PITSANULOKE ROAD
Practice Address - City:BANGKOK
Practice Address - State:BANGKOK
Practice Address - Zip Code:10300
Practice Address - Country:TH
Practice Address - Phone:662-282-1100
Practice Address - Fax:662-280-0441
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine