Healthcare Provider Details

I. General information

NPI: 1588765416
Provider Name (Legal Business Name): WALTER C. MAACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 UNIVERSITY AVENUE HEALDSBURG DISTRICT HOSPITAL
HEALDSBURG CA
95448
US

IV. Provider business mailing address

HEALDSBURG DISTRICT HOSPITAL 1375 UNIVERSITY AVENUE
HEALDSBURG CA
95448
US

V. Phone/Fax

Practice location:
  • Phone: 707-431-6500
  • Fax:
Mailing address:
  • Phone: 707-431-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG23577
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG23577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: