Provider Demographics
NPI:1366471138
Name:GASSER, WALTER E (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:GASSER
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 1:4 INDIGO RUN DR
Mailing Address - Street 2:#3610
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4150
Mailing Address - Country:US
Mailing Address - Phone:843-540-3231
Mailing Address - Fax:
Practice Address - Street 1:4 INDIGO RUN DR
Practice Address - Street 2:#3610
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-4150
Practice Address - Country:US
Practice Address - Phone:843-540-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC296753Medicaid
SC296753Medicaid
SCAA21705019Medicare PIN