Provider Demographics
NPI:1750375234
Name:WALTER, SHERI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:LYNN
Last Name:WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:GANGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8881 FLETCHER PKWY
Mailing Address - Street 2:STE 105
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3134
Mailing Address - Country:US
Mailing Address - Phone:619-499-2600
Mailing Address - Fax:619-462-3064
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:STE 105
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:619-499-2600
Practice Address - Fax:619-462-3064
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73372OtherSTATE LICENSE
CAZZZ36915ZMedicaid
CAZZZ36915ZMedicaid
CAZZZ36915ZMedicaid
CABW0965701OtherDEA