Provider Demographics
NPI:1144326752
Name:WALTERS, JOSEPH J (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12961 VILLAGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4158
Mailing Address - Country:US
Mailing Address - Phone:408-253-4806
Mailing Address - Fax:408-257-9701
Practice Address - Street 1:12961 VILLAGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4158
Practice Address - Country:US
Practice Address - Phone:408-253-4806
Practice Address - Fax:408-257-9701
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84144OtherMEDICAL LICENSE