MEDICARE: DR. HEIDI MARA WALTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	11600	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11600	OTHER	NV	NV STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1245254028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI MARA WALTER M.D.

Provider Business Mailing Address
First Line	:	1405 CHAMBOLLE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1136
Country	:	US
Telephone Number	:	702-341-9465
Fax Number	:	866-804-7676

Provider Business Practice Location Address
First Line	:	1405 CHAMBOLLE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1136
Country	:	US
Telephone Number	:	702-341-9465
Fax Number	:	866-804-7676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/07/2023

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