Individual
DR. NICHOLAS WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2927 N 7TH AVE, PEPPERTREE BUILDING - WINDOW #3, PHOENIX, AZ 85013-4102
(602) 406-3153
(602) 406-7176
Mailing address
2927 N 7TH AVE, PEPPERTREE BUILDING - WINDOW #3, PHOENIX, AZ 85013-4102
(602) 406-3153
(602) 406-7176
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R73521
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R73521
TRAINING PERMIT
CA
Enumeration date
06/25/2012
Last updated
06/25/2012
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