Individual
MRS. LAURA MARIE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1911 E REZANOF DR, KODIAK, AK 99615-6602
(907) 481-5000
(907) 481-5030
Mailing address
1911 E REZANOF DR, KODIAK, AK 99615-6602
(907) 481-5000
(907) 481-5030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4067
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920088665
CLINIC TAX ID
—
05
—
MD4067
—
AK
Enumeration date
02/09/2006
Last updated
12/06/2017
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