Individual
RUTH FULGHUM WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
200401447
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497968606
—
NC
01
—
179PM
BCNC
—
01
—
9234216
AETNA
—
01
—
NCD495A
MEDICARE
NC
Enumeration date
05/07/2007
Last updated
01/28/2015
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