Provider Demographics
NPI:1376614933
Name:SZYDLOWSKI, WALTER JOSEPH JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:JOSEPH
Last Name:SZYDLOWSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11347 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613
Mailing Address - Country:US
Mailing Address - Phone:352-596-1600
Mailing Address - Fax:352-596-4655
Practice Address - Street 1:11347 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-596-1600
Practice Address - Fax:352-596-4655
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME45152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
79908Medicare ID - Type Unspecified
D27279Medicare UPIN