Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO-1735 | FL |
N | 222Z00000X | Podiatrist | PO-1735 | FL |
Y | 213EP1101X | Primary Podiatric Medicine | PO-1735 | FL |
N | 111NR0200X | Radiology | PO1735 | FL |
N | 213ER0200X | Radiology | PO1735 | FL |
N | 2081S0010X | Sports Medicine | PO1735 | FL |
N | 213ES0000X | Sports Medicine | PO1735 | FL |
N | 213ES0103X | Foot & Ankle Surgery | PO1735 | FL |
N | 213ES0131X | Foot Surgery | PO-1735 | FL |
NPI | 1821105859 |
---|---|
Provider Name | Dr. Mary Jane Walter |
First Address | Palm Coast, FL 32137 |
Second Address | Palm Coast, FL 32137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T55623 | (02) |