Provider Demographics
NPI:1053402412
Name:RYAN K. WALTER, MD, PA
Entity type:Organization
Organization Name:RYAN K. WALTER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-626-3746
Mailing Address - Street 1:1713 S FM 51
Mailing Address - Street 2:201
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234
Mailing Address - Country:US
Mailing Address - Phone:940-626-3746
Mailing Address - Fax:940-627-4709
Practice Address - Street 1:1713 S FM 51
Practice Address - Street 2:201
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-626-3746
Practice Address - Fax:940-627-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024NZOtherBLUECROSS
TX0024NZOtherBLUECROSS