Provider Demographics
NPI:1497721161
Name:MUTH, WALTER N (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:N
Last Name:MUTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-1539
Mailing Address - Country:US
Mailing Address - Phone:207-667-6300
Mailing Address - Fax:207-667-9523
Practice Address - Street 1:128 BUCKSPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2239
Practice Address - Country:US
Practice Address - Phone:207-667-6300
Practice Address - Fax:207-667-9523
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME014860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME300850099Medicaid
ME300850099Medicaid
B75021Medicare UPIN