Provider Demographics
NPI:1790775880
Name:ALLISON, WALTER MURRAY III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:MURRAY
Last Name:ALLISON
Suffix:III
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 1:1400 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1708
Mailing Address - Country:US
Mailing Address - Phone:806-414-9100
Mailing Address - Fax:806-354-5717
Practice Address - Street 1:1400 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9100
Practice Address - Fax:806-354-5717
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6227207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000V4668Medicaid
OK100067330 AMedicaid
TX138795314Medicaid
TX138795316Medicaid
TX138795317Medicaid
TX138795316Medicaid
TX138795314Medicaid
NM000V4668Medicaid
TX8G7214Medicare PIN