Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1229 | FL |
NPI | 1558751362 |
---|---|
Provider Name | Dr. Walter Ray Earnest |
First Address | Tavares, FL 32778-5733 |
Second Address | Tavares, FL 32778-5733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2015 |
Last Update Date | 01/02/2015 |