Jarvis Wayne Walters, DO
Surgery in Peoria, AZ. Individual provider (NPI-1).
NPI number1508108945
StatusActive
Last updated in NPPESDec 6, 2023
Details
- NPI
- 1508108945
- Entity type
- Individual (NPI-1)
- Name
- Jarvis Wayne Walters
- Credential
- DO
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 25, 2013
- Certification date
- Dec 6, 2023
- Last updated
- Dec 6, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | 008056 | AZ | Yes |
| 208600000X | Surgery | DO034734 | DC | |
| 208600000X | Surgery | 05-42508 | KS |
Practice location
14155 N 83rd Ave Ste 105Peoria, AZ 85381-5640
Phone 623-486-7700 · Fax 623-486-7703
Mailing address
14155 N 83rd Ave Ste 105Peoria, AZ 85381-5640
Phone 623-486-7700 · Fax 316-945-9131
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