Individual
DR. MICHAEL JOHN WALTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
218547
MA
207P00000X
Emergency Medicine Physician
Primary
MD2008-0144
NM
Other
Enumeration date
12/12/2006
Last updated
01/07/2020
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