Provider Demographics
NPI:1255327730
Name:WALTER, JOHN HAROLD JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:WALTER
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827282
Mailing Address - Street 2:TEMPLE UNIVERSITY FEET & ANKLE INSTITUTE
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7282
Mailing Address - Country:US
Mailing Address - Phone:215-238-6600
Mailing Address - Fax:215-629-0716
Practice Address - Street 1:8 & RACE ST
Practice Address - Street 2:FEET & ANKLE INSTITUTE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:215-238-6600
Practice Address - Fax:215-629-4905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001877L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA28824OtherHEALTH PARTNERS
PA0005399980005Medicaid
PA6108067OtherCIGNA
PAWA032096OtherBLUE SHIELD OF PA
PA0060372000OtherKEYSTONE HEALTH PLAN HMO
NJ2264404OtherNJ MEDICAL ASSISTANCE
PAJ32096OtherINTER CITY
PA1003141OtherKEYSTONE MERCY
PA2179165OtherAETNA
PA999741OtherKEYSTONE HEALTH PLAN PPO
PA28824OtherHEALTH PARTNERS
PA6108067OtherCIGNA