Provider Demographics
NPI:1558751362
Name:EARNEST, WALTER RAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RAY
Last Name:EARNEST
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 1:2751 CORAL REEF WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5733
Mailing Address - Country:US
Mailing Address - Phone:407-782-6382
Mailing Address - Fax:
Practice Address - Street 1:2751 CORAL REEF WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5733
Practice Address - Country:US
Practice Address - Phone:407-782-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1229213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine