Provider Demographics
NPI:1609922541
Name:DUGGER, WALTER ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ROSS
Last Name:DUGGER
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 1:4934 VERDUGO WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8631
Mailing Address - Country:US
Mailing Address - Phone:805-484-0095
Mailing Address - Fax:805-388-2174
Practice Address - Street 1:4934 VERDUGO WAY
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8631
Practice Address - Country:US
Practice Address - Phone:805-484-0095
Practice Address - Fax:805-388-2174
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63647Medicare PIN
F34102Medicare UPIN