Healthcare Provider Details

I. General information

NPI: 1750309472
Provider Name (Legal Business Name): MATTHEW J WALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FOREST PARK AVE DIV IM BONE MARROW TRANSPLANT, 5TH, 6TH, 8TH FL
SAINT LOUIS MO
63108-2114
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8304
  • Fax: 314-454-5902
Mailing address:
  • Phone: 314-454-8304
  • Fax: 314-454-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number2003020148
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2003020148
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: