Individual
WALTER ETCHELLES DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
184 VIRGINIA STREET, BOONE, NC 28607
(828) 262-4332
(828) 265-5514
Mailing address
266 RIVER KNOLL PL, JEFFERSON, NC 28640-9392
(336) 982-3776
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15051
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0211X
BLUE CROSS BLUE SHIELD NC
NC
05
—
890211X
—
NC
Enumeration date
09/07/2006
Last updated
07/08/2007
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