Individual
BRADLEY WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 225-2500
(505) 225-2025
Mailing address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 225-2500
(505) 225-2025
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2013-0052
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58688005
—
NM
Enumeration date
08/15/2013
Last updated
11/04/2025
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