Provider Demographics
NPI:1922063742
Name:FLESNER, WALTER B III (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:B
Last Name:FLESNER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1404 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3774
Mailing Address - Country:US
Mailing Address - Phone:239-772-3232
Mailing Address - Fax:239-458-3272
Practice Address - Street 1:1404 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 110
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3774
Practice Address - Country:US
Practice Address - Phone:239-772-3232
Practice Address - Fax:239-458-3272
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066841900Medicaid
FLE32243Medicare UPIN
FL066841900Medicaid