Individual
MARK WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MO
Contact information
Practice address
747 52ND STREET, OAKLAND, CA 94609
(510) 428-3374
(510) 601-3916
Mailing address
5528 PACHECO BLVD A, PACHECO, CA 94553
(925) 363-8170
(925) 363-4995
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
G85406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G854060
—
CA
Enumeration date
10/12/2006
Last updated
07/08/2007
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