Douglas Craig Walta MD

NPI 1023001195 - Internal Medicine - 207RG0100X

NPI Details
NPI 1023001195
Gender Male
Enumeration Date 08/24/2005
Last Updated 08/05/2008
Entity Type Individual
Active Over 11 years ago
Practice Location
1111 NE 99TH AVE
SUITE 301
PORTLAND OR, 97220-9428, US
Phone (503) 963-2707
Fax (503) 963-2802
Business Location
975 SE SANDY BLVD
SUITE 200
PORTLAND OR, 97214-1308, US
Phone (503) 963-2846
Fax (503) 963-9505
Toxanomy
Taxonomy Code 207RG0100X
License State Oregon
License Number MD09846
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According to our database, Douglas Craig Walta MD NPI is 1023001195, taxonomy code is 207RG0100X and license number is MD09846, license state is located at Oregon. Douglas Craig Walta MD physically located at 1111 Ne 99th Ave, Portland OR, 97220-9428. NPI Number Douglas Craig Walta MD has the Individual type.

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1023001195 NPI number is provided on an as is basis without warranty of any kind. 1023001195 is maintained by the National Plan & Provider Enumeration System. The contents of Douglas Craig Walta MD are for informational purposes only.