Provider Demographics
NPI:1902819691
Name:WALTERS, ALTON J (MD)
Entity Type:Individual
Prefix:
First Name:ALTON
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALTON 'AL'
Other - Middle Name:JOSEPH
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:5230 BOULDER HWY STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6077
Practice Address - Country:US
Practice Address - Phone:702-940-1560
Practice Address - Fax:702-940-1561
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4017OtherSTATE LICENSE
NV1902819691Medicaid