Individual
DR. WALTER CLARK BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 HUNTER TRL, PIKE ROAD, AL 36064-3415
(334) 657-7198
(334) 272-4876
Mailing address
207 HUNTER TRL, PIKE ROAD, AL 36064-3415
(334) 657-7198
(334) 272-4876
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD-014439-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001312743
—
CT
05
—
4630520
—
MI
Enumeration date
04/01/2006
Last updated
08/28/2012
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