Individual
MR. RANDALL WAYNE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 FLEMING DR, HARTS, WV 25524-9788
(304) 855-4595
(304) 855-9377
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
(304) 697-1396
(304) 697-2086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22354
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005193
—
WV
01
—
P01128276
MEDICARE RR PTAN
WV
Enumeration date
04/25/2006
Last updated
05/29/2015
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