Provider Demographics
NPI:1326164716
Name:WALTER S PISKUN MD PA
Entity Type:Organization
Organization Name:WALTER S PISKUN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:PISKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-350-7813
Mailing Address - Street 1:3501 S SONCY RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6407
Mailing Address - Country:US
Mailing Address - Phone:806-350-7813
Mailing Address - Fax:
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:SUITE 126
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-350-7813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00955YMedicare PIN