Provider Demographics
NPI:1609832799
Name:WALTERS, DAVID LEE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
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 1:7979 W VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3798
Mailing Address - Country:US
Mailing Address - Phone:972-296-4828
Mailing Address - Fax:972-296-0105
Practice Address - Street 1:7979 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3798
Practice Address - Country:US
Practice Address - Phone:972-296-4828
Practice Address - Fax:972-296-0105
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CY851OtherBLUE CROSS
TX123775212Medicaid
TXC23146Medicare UPIN
TX123775212Medicaid