Provider Demographics
NPI:1710378955
Name:WALTERS, COURT CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:COURT
Middle Name:CARROLL
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:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:ALLENSPARK
Mailing Address - State:CO
Mailing Address - Zip Code:80510-0523
Mailing Address - Country:US
Mailing Address - Phone:303-747-2461
Mailing Address - Fax:
Practice Address - Street 1:33 N SKINNER RD
Practice Address - Street 2:
Practice Address - City:ALLENSPARK
Practice Address - State:CO
Practice Address - Zip Code:80510-0523
Practice Address - Country:US
Practice Address - Phone:303-747-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054782207Q00000X
TN29106207Q00000X
NC9701191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine