Provider Demographics
NPI:1265488258
Name:NIERI, WALTER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOHN
Last Name:NIERI
Suffix:
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 1:6510 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8943
Mailing Address - Country:US
Mailing Address - Phone:902-885-1988
Mailing Address - Fax:602-952-9750
Practice Address - Street 1:6510 N 27TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8943
Practice Address - Country:US
Practice Address - Phone:602-885-1988
Practice Address - Fax:602-951-9750
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6055207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00038Medicare UPIN
Z124152Medicare PIN
AZ29344Medicare ID - Type Unspecified