Individual
JACOB ANDREW WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3050 E RIVER BLUFF BLVD, OZARK, MO 65721-8807
(417) 885-3000
(717) 737-7197
Mailing address
3050 E RIVER BLUFF BLVD, OZARK, MO 65721-8807
(417) 885-3000
(717) 737-7197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021024722
MO
363A00000X
Physician Assistant
MA055982
PA
363AM0700X
Medical Physician Assistant
MA055982
PA
363AS0400X
Surgical Physician Assistant
MA055982
PA
Other
Enumeration date
02/11/2013
Last updated
08/18/2021
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