Healthcare Provider Details

I. General information

NPI: 1932187515
Provider Name (Legal Business Name): JOHN A WALTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2384 N MEMORIAL DR
LANCASTER OH
43130-1637
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-4935
  • Fax: 740-689-4889
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number34.007840
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34.007840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: