Walter P Vickers Jr., D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

5198 Issued in AL

Practice address

1200 Montlimar Dr
Mobile, AL 36609-1711

Phone

(251) 342-0380

Fax

(251) 344-3063

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 4, 2016 through Apr 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Roots Family and Cosmetic Dentistry

  • Dental Clinic/Center
  • Mobile, AL
  • NPI 1336973999
  NPD Authorized official
• Walter P Vickers Jr. DMD PC

  • General Practice Dentistry
  • Mobile, AL
  • NPI 1144056409
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238371200000",
    "number": "1972525483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MONTLIMAR DR",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366091711",
            "telephone_number": "251-342-0380",
            "fax_number": "251-344-3063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MONTLIMAR DR",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366091711",
            "telephone_number": "251-342-0380",
            "fax_number": "251-344-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERS",
        "first_name": "WALTER",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2009-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "5198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Fawn Vial, CRNA
• Vibrant Community Homes, Inc.
• Valerie Lanette Vick, M.D.
• Macy Juel Vickers
• Stormi W Vickers, AUD
• Laurie Vickery, CRNP
• Bethany K.V. Vickrey, FNP-C
• Robert Adam Vickrey, MSN-FNP
• Sarah Jo Vickrey, CRNP
• Victory Home Care

• Dentist in Mobile, AL
• Providers in Mobile, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.