Provider Demographics
NPI:1518288778
Name:WALIMIRE, PETER BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRIAN
Last Name:WALIMIRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13782 PLANTATION RD STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4462
Mailing Address - Country:US
Mailing Address - Phone:239-204-5602
Mailing Address - Fax:239-309-0645
Practice Address - Street 1:13782 PLANTATION RD STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:239-204-5602
Practice Address - Fax:239-309-0645
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3405213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6503BOtherBCBS
FLE0934YMedicare PIN
FL6503BOtherBCBS
FL0626040001Medicare NSC