Provider Demographics
NPI:1588651558
Name:WALTERS, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2332
Mailing Address - Country:US
Mailing Address - Phone:812-522-1222
Mailing Address - Fax:812-522-1558
Practice Address - Street 1:410 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2332
Practice Address - Country:US
Practice Address - Phone:812-522-1222
Practice Address - Fax:812-522-1558
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01032854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100352130AMedicaid
IN380260BMedicare ID - Type Unspecified
IND94798Medicare UPIN