Healthcare Provider Details

I. General information

NPI: 1740232917
Provider Name (Legal Business Name): WALTER I CHOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W MUSTANG BLVD
BEVERLY HILLS FL
34465-0580
US

IV. Provider business mailing address

PO BOX 640580
BEVERLY HILLS FL
34465-0580
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-5707
  • Fax: 352-746-5944
Mailing address:
  • Phone: 352-746-5707
  • Fax: 352-746-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0066779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: