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NPI Code Detail

MEDICARE: DR. GENELLE A WALTERS D.O.

MEDICARE: DR. GENELLE A WALTERS D.O.
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
1207V00000XObstetrics & Gynecology PhysicianOS11470FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023270220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GENELLE A WALTERS D.O.
Provider Business Mailing Address
First Line : 110 S WOODLAND ST
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-3546
Country : US
Telephone Number : 407-905-8827
Fax Number : 407-209-3220
Provider Business Practice Location Address
First Line : 840 MERCY DR
Second Line :
City : ORLANDO
State : FL
Zip : 32808-7820
Country : US
Telephone Number : 407-905-8827
Fax Number : 407-209-3220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2008
Last Update Date : 05/01/2018

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Directions to “ DR. GENELLE A WALTERS D.O.” Practice Location

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