Provider Demographics
NPI:1639259294
Name:WALTERS, NATHAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SCOTT
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 1:7115 GREENVILLE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5104
Mailing Address - Country:US
Mailing Address - Phone:214-888-3888
Mailing Address - Fax:214-888-3889
Practice Address - Street 1:7115 GREENVILLE AVE STE 230
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5104
Practice Address - Country:US
Practice Address - Phone:214-888-3900
Practice Address - Fax:214-888-3901
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL75952081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL7595OtherTMB
TX8J4724Medicare PIN