Provider Demographics
NPI:1952311870
Name:CONLAN, WALTER A III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:A
Last Name:CONLAN
Suffix:III
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 1:55 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1113
Mailing Address - Country:US
Mailing Address - Phone:321-841-5469
Mailing Address - Fax:321-841-7470
Practice Address - Street 1:55 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1113
Practice Address - Country:US
Practice Address - Phone:321-841-5469
Practice Address - Fax:321-841-7470
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70963208100000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250013030OtherRAILROAD MEDICARE
FL251971200Medicaid
FL31555YMedicare PIN
FL250013030OtherRAILROAD MEDICARE