Individual
CODY A WALTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1109 E BROADWAY ST, CUERO, TX 77954
(361) 275-2800
(361) 275-8791
Mailing address
1109 E BROADWAY ST, CUERO, TX 77954-2108
(361) 275-2800
(361) 275-8791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E-10831
AR
207Q00000X
Family Medicine Physician
Primary
S2925
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400778302
—
TX
01
—
842333
MEDICARE
TX
01
—
S2925
STATE LIC
TX
Enumeration date
04/24/2016
Last updated
08/18/2022
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