Individual
WALTER SCOTT EDWARDS MEDLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1046 E 100 S, SUITE A, SALT LAKE CITY, UT 84102-1520
(406) 694-2487
(801) 746-2886
Mailing address
1046 E 100 S, SUITE A, SALT LAKE CITY, UT 84102-1520
(406) 694-2487
(801) 746-2886
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
12854
MT
208600000X
Surgery Physician
47825-020
WI
208600000X
Surgery Physician
8984752-1205
UT
208600000X
Surgery Physician
MD00037282
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0248634
L&I AND CRIME VICTIMS
WA
01
—
1008ME
REGENCE
WA
05
—
1932156692
—
WA
01
—
7762232
AETNA
WA
05
—
976488700
—
MN
05
—
MD0608W
—
AK
Enumeration date
05/28/2006
Last updated
08/21/2014
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