Provider Demographics
NPI:1316991045
Name:WALTER, GAIL ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ELIZABETH
Last Name:WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 LAKEVIEW CIR S
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1395
Mailing Address - Country:US
Mailing Address - Phone:913-557-5641
Mailing Address - Fax:
Practice Address - Street 1:3003 LAKEVIEW CIR S
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1395
Practice Address - Country:US
Practice Address - Phone:913-557-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004023934207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10011Medicare UPIN