Individual
DR. JACK ALLISON WALTERS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8335 WALNUT HILL LN, SUITE 215, DALLAS, TX 75231
(214) 696-8080
(214) 696-2658
Mailing address
8335 WALNUT HILL LN, SUITE 215, DALLAS, TX 75231
(214) 696-8080
(214) 696-2658
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E3797
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235749D2
MEDICAID
TX
05
—
1235749D4
—
TX
Enumeration date
02/16/2007
Last updated
07/08/2007
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