Provider Demographics
NPI:1154363315
Name:CHATHAM, WALTER
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:CHATHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1973
Mailing Address - Country:US
Mailing Address - Phone:702-780-2315
Mailing Address - Fax:
Practice Address - Street 1:1707 W CHARLESTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2353
Practice Address - Country:US
Practice Address - Phone:702-671-6469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12575207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051592847OtherBCBS
MS06487244Medicaid
110035912OtherRAILROAD MEDICARE
AL4023140OtherBCBS
ALA96706OtherVIVA
AL000015850OtherBLUE CROSS
AL009910787Medicaid
AL000015850Medicaid
AL103904Medicaid
AL110035912OtherRAILROAD MEDICARE
AL6116OtherHEALTHSPRING
AL009910787Medicaid