Individual
THEODORE A WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6267
(208) 381-2711
(208) 381-4025
Mailing address
1923S ROOSEVELT ST, BOISE, ID 83705-3259
(208) 861-2589
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
M3117
ID
207RX0202X
Medical Oncology Physician
Primary
M3117
ID
Other
Enumeration date
07/18/2006
Last updated
12/28/2015
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