Provider Demographics
NPI:1881681492
Name:WALTER, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3251 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2022
Mailing Address - Country:US
Mailing Address - Phone:727-669-6242
Mailing Address - Fax:
Practice Address - Street 1:3251 N MCMULLEN BOOTH RD
Practice Address - Street 2:STE 102
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2022
Practice Address - Country:US
Practice Address - Phone:727-669-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME41933207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D65348Medicare UPIN
FL62411Medicare PIN