Provider Demographics
NPI:1366436149
Name:WALTER, JAMES WIGGINS (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WIGGINS
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 INNER CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36113-1101
Mailing Address - Country:US
Mailing Address - Phone:334-356-7596
Mailing Address - Fax:334-953-5201
Practice Address - Street 1:300 SOUTH TWINING STREET
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6219
Practice Address - Country:US
Practice Address - Phone:334-953-5675
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15016207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services