Individual
WALTER ELIAS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5722 INTEGRITY DRIVE BLDG. S771, OFFICER IN CHARGE BRANC, MILLINGTON, TN 38054-5021
(901) 874-6100
Mailing address
5720 INTEGRITY DRIVE, COMMANDING OFFICER PERS-4821B, MILLINGTON, TN 38055-4821
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101044337
VA
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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