Provider Demographics
NPI:1336129725
Name:GARNER, WALTER G III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:G
Last Name:GARNER
Suffix:III
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 1:1665 KINGSLEY AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4490
Mailing Address - Country:US
Mailing Address - Phone:904-269-6565
Mailing Address - Fax:904-264-0529
Practice Address - Street 1:1665 KINGSLEY AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4490
Practice Address - Country:US
Practice Address - Phone:904-269-6565
Practice Address - Fax:904-264-0529
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI15340Medicare UPIN
FL43293Medicare ID - Type Unspecified