Provider Demographics
NPI:1831695642
Name:WALTHER, JAMES GRANT
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GRANT
Last Name:WALTHER
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 1:16408 JEANIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-702-0261
Mailing Address - Fax:
Practice Address - Street 1:16408 JEANIE DRIVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-702-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
824454651OtherFEDERAL TAX IDENTIFICATION NUMBER