Provider Demographics
NPI:1134422991
Name:WALTCHER, STEPHEN GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GLENN
Last Name:WALTCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-0062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5858 EMPIRE GRADE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-9603
Practice Address - Country:US
Practice Address - Phone:208-721-2868
Practice Address - Fax:831-208-2078
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88413208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice