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MRS. TRICIA A WALTERS M.D.

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1114125739

Individual Registrant:
MRS. TRICIA A WALTERS M.D.
Gender: F
Sole Proprietor

Location and contact information for practice:
66642 SR 331  WYATT, IN 46595-0027 US
Tel: 574-633-4511  Fax: 574-633-0281

Contact information for business:
PO BOX 90  WYATT, IN 46595-0027 US
Tel: 574-633-4511  Fax: 574-633-0281

Registration Information:
NPI: 1114125739
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
IN01065500A

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
200928780AIN05
MEDICAL RESIDENCY PERMIT11013720AIN01
MEDICARE PTAN169380065IN01
MEDICARE PTAN236040229IN01




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