Doctor Name: | DR. WALTON W GROTE |
NPI Number: | 1053367219 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | R-4003 |
Business Practice Address: | 3396 N Futrall Dr Suite 1 Fayetteville, AR - 727034057 |
Business Phone Number: | 4795821938 |
Business Fax Number: | 4795870484 |
Mailing Address: | 3396 N Futrall Dr, Suite 1 FAYETTEVILLE |
State: | AR |
Postal Code: | 727034057 |
Phone Number: | 4795821938 |
Fax Number: | 4795870484 |
NPI Enumeration Date: | 05/26/2006 |
NPI Last Update Date: | 03/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | R-4003 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |