Provider Demographics
NPI:1154498400
Name:WALTON, PETER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:WALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:10933 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2630
Mailing Address - Country:US
Mailing Address - Phone:813-854-1919
Mailing Address - Fax:813-854-2525
Practice Address - Street 1:10933 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2630
Practice Address - Country:US
Practice Address - Phone:813-854-1919
Practice Address - Fax:813-854-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42662BMedicare ID - Type Unspecified
FLG31216Medicare UPIN