Provider Demographics
NPI:1699798157
Name:WALTERS, RONALD DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DEAN
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18384
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4078
Mailing Address - Country:US
Mailing Address - Phone:910-255-0033
Mailing Address - Fax:910-255-0036
Practice Address - Street 1:293 OLMSTED BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9023
Practice Address - Country:US
Practice Address - Phone:910-255-0033
Practice Address - Fax:910-255-0036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200101405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200101405OtherSTATE MEDICAL LISCENCE #
C32174Medicare UPIN