Individual
LARRY L WALTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
21 W CENTRAL AVE, MIAMI, OK 74354-6815
(918) 542-3900
(918) 542-3928
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(918) 540-7758
(918) 540-7763
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
681
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100186200A
—
OK
05
—
200468380F
—
OK
Enumeration date
06/14/2005
Last updated
02/24/2020
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