| Doctor Name: | DR. STEPHEN GLENN WALTCHER |
| NPI Number: | 1134422991 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 287532-1205 |
| Business Practice Address: | 140 Dubois St Suite A Santa Cruz, CA - 950602175 |
| Business Phone Number: | 8314570420 |
| Business Fax Number: | |
| Mailing Address: | Po Box 62, FELTON |
| State: | CA |
| Postal Code: | 950180062 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/15/2010 |
| NPI Last Update Date: | 12/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 287532-1205 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |