Walta, Douglas Craig
Walta, Douglas Craig is an individual health care provider with primary practice located at 1111 Ne 99Th Ave Suite 301, Portland OR 97220-9428. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Walta, Douglas Craig can be contacted via phone (503) 963-2707.Contact Information
Primary practice address
1111 Ne 99Th Ave Suite 301
Portland OR 97220-9428
Phone: (503) 963-2707
Fax: (503) 963-2802
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | MD09846 | Oregon |
Profile Details
| NPI number | 1023001195 |
|---|---|
| LBN Legal business name | Walta, Douglas Craig |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2005 |
| Last updated | Aug 5th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023001195 | NPPES |
| Oregon | MEDICAID | 230979 | |
| Oregon | MEDICAID | 1872308 |
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