Boutwell, Walter Clark
Boutwell, Walter Clark is an sole proprietor health care provider with primary practice located at 207 Hunter Trl , Pike Road AL 36064-3415. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, which is considered as his primary health care specialty. Boutwell, Walter Clark can be contacted via phone (334) 657-7198.Contact Information
Primary practice address
207 Hunter Trl
Pike Road AL 36064-3415
Phone: (334) 657-7198
Fax: (334) 272-4876
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine | 2080N0001X | MD-014439-E | Pennsylvania |
Profile Details
| NPI number | 1316908809 |
|---|---|
| LBN Legal business name | Boutwell, Walter Clark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 1st, 2006 |
| Last updated | Aug 28th, 2012 - about 12 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 | 1316908809 | NPPES |
| Connecticut | MEDICAID | 001312743 | |
| Connecticut | MEDICAID | 4630520 |
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