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Individual

DR. WALTER FRIZZELL FLETCHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
117 KENNEDY DR, MARTIN, TN 38237-3309
(731) 587-9511
(731) 587-0785
Mailing address
424 W 4TH ST, WATERLOO, IL 62298-1378
(877) 748-7030
(877) 264-9140

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25879
TN
207Q00000X
Family Medicine Physician
Primary
25879
TN
207R00000X
Internal Medicine Physician
25879
TN
208000000X
Pediatrics Physician
25879
TN
208100000X
Physical Medicine & Rehabilitation Physician
25879
TN
2085R0202X
Diagnostic Radiology Physician
25879
TN
208600000X
Surgery Physician
25879
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
30848602
MEDICARE
TN
05
30848602
TN
01
4173958
BLUE CROSS AND BLUE SHIELD
TN
01
JT1036
CIGNA
TN
01
P00034971
RAILROAD MEDICARE
TN
Enumeration date
10/27/2005
Last updated
06/12/2024
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