Provider Demographics
NPI:1295949428
Name:WALTER, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27598207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009914087Medicaid
AL515-99334OtherBCBS
AL009912907Medicaid
AL051544669OtherBCBS
AL051545799OtherBCBS
AL1295949428OtherTRICARE SOUTH
AL051544668OtherBCBS
AL051559839Medicaid
AL7564330OtherAETNA
AL112700Medicaid
AL112715Medicaid
AL009914087Medicaid
AL112700Medicaid
AL510I930126Medicare PIN
ALP00750235Medicare PIN
AL510I930002Medicare PIN
AL051544669OtherBCBS
ALP00425092Medicare PIN