Provider Demographics
NPI:1235175233
Name:MAIER, WALTER M (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:M
Last Name:MAIER
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:CEDAR GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:92321-1141
Mailing Address - Country:US
Mailing Address - Phone:909-337-3661
Mailing Address - Fax:909-337-3570
Practice Address - Street 1:29099 HOSPITAL ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-3661
Practice Address - Fax:909-337-3570
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82114207P00000X, 2083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04002Medicare UPIN