Provider Demographics
NPI:1790033900
Name:AMBROSE, WALTER JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOSEPH
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 NEWFOREST CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-2619
Mailing Address - Country:US
Mailing Address - Phone:817-465-3074
Mailing Address - Fax:
Practice Address - Street 1:2303 NEWFOREST CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-2619
Practice Address - Country:US
Practice Address - Phone:817-465-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7154202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner