Individual
DR. WALTER LEE FANNING JR.
Active
Individual
DR. WALTER LEE FANNING JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
2006-00672
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00339806
RAILROAD MEDICARE
NC
01
—
142K2
BCBSNC
NC
01
—
1527547
CIGNA
NC
01
—
190800
MEDCOST
NC
01
—
2055819A
MEDICARE PTAN, INDIVIDUAL
NC
01
—
232009
MEDICARE PTAN, GROUP
NC
01
—
4302912
AETNA
NC
05
—
5903747
—
NC
01
—
808032
PARTNERS MEDICARE CHOICE
NC
Enumeration date
03/07/2006
Last updated
07/13/2010
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