MEDICARE: DR. JOEL F WALTZER 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	174400000X	Specialist	ME76052	FL
2	207N00000X	Dermatology Physician	ME76052	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	:	1467416180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL F WALTZER M.D.

Provider Business Mailing Address
First Line	:	15051 S TAMIAMI TRL
Second Line	:	SUITE 203
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5182
Country	:	US
Telephone Number	:	239-437-8810
Fax Number	:	239-313-2555

Provider Business Practice Location Address
First Line	:	1108 GOODLETTE RD N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5451
Country	:	US
Telephone Number	:	239-434-0303
Fax Number	:	239-262-8730

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	09/14/2016

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