Basic Information
| Provider Information | |||||||||
| NPI: | 1760405856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | COOPER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2980 SQUALICUM PKWY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606473377 | ||||||||
| FaxNumber: | 3607523214 | ||||||||
| Practice Location | |||||||||
| Address1: | 2980 SQUALICUM PKWY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606473377 | ||||||||
| FaxNumber: | 3607523214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 01/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD00036764 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 50062634 | 01 | WA | MEDICARE RR | OTHER | 8237331 | 05 | WA | MEDICAID |