Provider Demographics
NPI:1447680301
Name:WALTER L. FLETSCHER, M.D., INC.
Entity type:Organization
Organization Name:WALTER L. FLETSCHER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:FLETSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-949-4128
Mailing Address - Street 1:2510 AIRPARK DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2449
Mailing Address - Country:US
Mailing Address - Phone:530-241-9966
Mailing Address - Fax:530-241-9783
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE 302
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-241-9966
Practice Address - Fax:530-241-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486440Medicaid
CA00G486440Medicaid