Provider Demographics
NPI:1053349779
Name:WALTERS, DONALD ARTHUR (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ARTHUR
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-6062
Mailing Address - Fax:724-482-6117
Practice Address - Street 1:104 TECHNOLOGY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:724-482-6062
Practice Address - Fax:724-482-6117
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S007169L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016474610008Medicaid
PAG35767Medicare UPIN
PA0016474610008Medicaid