Individual
JACK RYAN WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9040 JACKSON AVE MAMC UROLOGY, TACOMA, WA 98431
(253) 968-2300
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD60267047
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306879366
—
WA
01
—
P01715983
RR MEDICARE WVH
WA
Enumeration date
07/09/2006
Last updated
02/12/2019
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