Provider Demographics
NPI:1568795144
Name:WALTER J SZYDLOWSKI JR MD PA
Entity Type:Organization
Organization Name:WALTER J SZYDLOWSKI JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SZYDLOWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-1600
Mailing Address - Street 1:11347 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5404
Mailing Address - Country:US
Mailing Address - Phone:352-596-1600
Mailing Address - Fax:352-596-4655
Practice Address - Street 1:11347 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5404
Practice Address - Country:US
Practice Address - Phone:352-596-1600
Practice Address - Fax:352-596-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110011399OtherRR MEDICARE
FLD27279Medicare UPIN
FL110011399OtherRR MEDICARE