Provider Demographics
NPI:1972598654
Name:PHARR, WALTER DAVIDSON (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DAVIDSON
Last Name:PHARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1511 WESTOVER TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7128
Mailing Address - Country:US
Mailing Address - Phone:336-373-0611
Mailing Address - Fax:336-373-1589
Practice Address - Street 1:1511 WESTOVER TER
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7128
Practice Address - Country:US
Practice Address - Phone:336-373-0611
Practice Address - Fax:336-373-1589
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901670Medicaid
NC8901670Medicaid
NC2141729AMedicare ID - Type Unspecified