Provider Demographics
NPI:1417954546
Name:WALTER, JOHN PEYTON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PEYTON
Last Name:WALTER
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 1:1500 EXPO PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4227
Mailing Address - Country:US
Mailing Address - Phone:916-646-8300
Mailing Address - Fax:916-920-4434
Practice Address - Street 1:3161 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5234
Practice Address - Country:US
Practice Address - Phone:916-453-9999
Practice Address - Fax:916-739-1099
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG307602085B0100X, 2085N0700X, 2085N0904X, 2085R0202X, 2085R0203X, 2085R0204X, 2085R0205X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G307600Medicare PIN
CA00G307606Medicare PIN
A44538Medicare UPIN