Provider Demographics
NPI:1760482137
Name:WALTER, JOSEPH ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 BANKS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6020
Mailing Address - Country:US
Mailing Address - Phone:713-522-8760
Mailing Address - Fax:713-522-8790
Practice Address - Street 1:1526 BANKS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6020
Practice Address - Country:US
Practice Address - Phone:713-522-8760
Practice Address - Fax:713-522-8790
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23140Medicare UPIN
TX00AN894Medicare ID - Type Unspecified