Provider Demographics
NPI:1801131974
Name:RONALD WALTERS, MD
Entity type:Organization
Organization Name:RONALD WALTERS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-255-0033
Mailing Address - Street 1:293 OLMSTED BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9181
Mailing Address - Country:US
Mailing Address - Phone:910-255-0033
Mailing Address - Fax:910-255-0036
Practice Address - Street 1:293 OLMSTED BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9181
Practice Address - Country:US
Practice Address - Phone:910-255-0033
Practice Address - Fax:910-255-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty