MEDICARE: SAMUEL WALTERS D.O.

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	207Q00000X	Family Medicine Physician	OS8337	FL

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

General Provider Information

NPI Number	:	1336119817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL WALTERS D.O.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 103RD ST STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-6788
Country	:	US
Telephone Number	:	904-683-4968
Fax Number	:	904-902-1202

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	02/06/2024

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