Provider Demographics
NPI:1467870261
Name:WALTER, JESSICA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUTH
Last Name:WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 2400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3907
Mailing Address - Country:US
Mailing Address - Phone:312-695-7269
Mailing Address - Fax:312-695-4924
Practice Address - Street 1:259 E ERIE ST STE 2400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-695-7269
Practice Address - Fax:312-695-4924
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125065238207V00000X
IL036156432207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology