Provider Demographics
NPI:1235276700
Name:WALTERS, KEVIN CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CRAIG
Last Name:WALTERS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-375-5738
Practice Address - Street 1:520 S EAGLE RD STE 2213
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6354
Practice Address - Country:US
Practice Address - Phone:208-706-5447
Practice Address - Fax:208-706-5448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD257722083P0011X, 2083X0100X
IDM-156332083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine