Provider Demographics
NPI:1063622322
Name:HINSHAW, WALTER DUANE (DO)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DUANE
Last Name:HINSHAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7957
Mailing Address - Country:US
Mailing Address - Phone:972-276-6822
Mailing Address - Fax:972-487-4060
Practice Address - Street 1:2201 FOREST LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7957
Practice Address - Country:US
Practice Address - Phone:972-276-6822
Practice Address - Fax:972-487-4060
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R003Medicare PIN
TX8C0891Medicare PIN
D97400Medicare UPIN