Provider Demographics
NPI:1053352773
Name:HARGETT, WALTER (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:HARGETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 LUSK DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8855
Mailing Address - Country:US
Mailing Address - Phone:417-451-2060
Mailing Address - Fax:417-451-6214
Practice Address - Street 1:2550 LUSK DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-8855
Practice Address - Country:US
Practice Address - Phone:417-451-2060
Practice Address - Fax:417-451-6214
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D90207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200207220AMedicaid
MO203466727Medicaid
E58092Medicare UPIN
MOMA5102002Medicare PIN