# MR. GERALD KEITH WALTERS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1104888015
- **Gender:** Man
- **Credential:** MS, PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | C-00072 | MD | Yes |
| 363AS0400X | Surgical Physician Assistant | C0000072 | MD | — |

## Other

- **Enumeration date:** 04/05/2006
- **Last updated:** 03/07/2023