Provider Demographics
NPI:1366732117
Name:WALTHER, STEWART LANE (MD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:LANE
Last Name:WALTHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC10-5550
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4253
Practice Address - Fax:505-272-4356
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2018-03-20
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Provider Licenses
StateLicense IDTaxonomies
NMMD2017-0897207RC0000X, 207R00000X
NMRS2011-0333390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program