Provider Demographics
NPI:1285959205
Name:WALTERS, ELAINE CHIU (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CHIU
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:CHIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3041 CHURCHILL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5906
Mailing Address - Country:US
Mailing Address - Phone:972-691-1240
Mailing Address - Fax:972-691-2073
Practice Address - Street 1:3041 CHURCHILL DR STE 300
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5906
Practice Address - Country:US
Practice Address - Phone:972-691-1240
Practice Address - Fax:972-691-2073
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6108208000000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program