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Individual

EARL THOMAS WALTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
401 S WASHINGTON AVE, IOLA, KS 66749-3256
(620) 365-6933
(620) 365-8126
Mailing address
PO BOX 764, WICHITA, KS 67201-0764
(620) 365-6933
(620) 365-8126

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05-16916
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100098460 B
KS
Enumeration date
04/19/2006
Last updated
09/04/2013
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