Provider Demographics
NPI:1689630816
Name:WALTHER, CARA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:E
Last Name:WALTHER
Suffix:
Gender:F
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:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-1231
Mailing Address - Country:US
Mailing Address - Phone:541-410-5081
Mailing Address - Fax:208-203-1893
Practice Address - Street 1:241 SKIWAY DR
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:541-410-5081
Practice Address - Fax:208-203-1893
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21891207XX0005X
IDM14634207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200036915OtherRAILROAD MEDICARE
OR134131Medicaid
OR104928Medicare PIN