Provider Demographics
NPI:1962486548
Name:WALTERS, SUSAN JS (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JS
Last Name:WALTERS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:6005 244TH ST SW
Mailing Address - Street 2:STE. 111
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5400
Mailing Address - Country:US
Mailing Address - Phone:425-275-5555
Mailing Address - Fax:425-275-5590
Practice Address - Street 1:6005 244TH ST SW
Practice Address - Street 2:STE. 111
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5400
Practice Address - Country:US
Practice Address - Phone:425-275-5555
Practice Address - Fax:425-275-5590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WA28645208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology