Individual
DR. WALTER J. FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 CENTER AVE, JIM THORPE, PA 18229-1205
(817) 845-1968
Mailing address
211 CENTER AVE, JIM THORPE, PA 18229-1205
(817) 845-1968
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MD035284E
PA
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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