Provider Demographics
NPI:1548394539
Name:WALTHER, ROBERT A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:WALTHER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3705 JERICHO DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6018
Mailing Address - Country:US
Mailing Address - Phone:407-388-0528
Mailing Address - Fax:407-388-0528
Practice Address - Street 1:250 EAST FOURTH AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-0001
Practice Address - Country:US
Practice Address - Phone:352-735-1400
Practice Address - Fax:352-735-3300
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101024363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ53667Medicare UPIN