Individual
DR. ELLEN D. WALTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 JENNY GEORGE LN, SWEETWATER, TX 79556-7152
(325) 236-8886
(325) 236-8861
Mailing address
2162 COUNTY ROAD 1403, LOMETA, TX 76853-3444
(417) 718-5754
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
J0343
TX
207Q00000X
Family Medicine Physician
J0343
TX
208600000X
Surgery Physician
Primary
J0343
TX
Other
Enumeration date
11/13/2006
Last updated
01/31/2019
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