# WALTERS FAMILY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Larry Goss M.D.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346428521
- **Authorized official:** MRS. GLORIA E VAUGHN (OFFICE MANAGER)
- **Authorized official phone:** (580) 875-3320

## Contact information

- **Practice address:** 102 N BROADWAY ST, WALTERS, OK 73572-1258
- **Practice address phone:** (580) 875-3320
- **Practice address fax:** (580) 875-3131
- **Mailing address:** 102 N BROADWAY ST, WALTERS, OK 73572-1258
- **Mailing address phone:** (580) 875-3320
- **Mailing address fax:** (580) 875-3131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 10340 | OK | Yes |

## Other

- **Enumeration date:** 02/10/2008
- **Last updated:** 06/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200134580A | — | OK |
| 01 | — | 37D1084232 | CLIA | OK |