Provider Demographics
NPI:1235465691
Name:WALTERS, JOSEPH WILLIAM JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:WALTERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1817
Mailing Address - Country:US
Mailing Address - Phone:585-385-1432
Mailing Address - Fax:585-385-5848
Practice Address - Street 1:54 MOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1817
Practice Address - Country:US
Practice Address - Phone:585-385-1432
Practice Address - Fax:585-385-5848
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154717-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology