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NPI Code Detail

MEDICARE: WALTER FRANCIS D'COSTA D.P.M.

MEDICARE:   WALTER FRANCIS D'COSTA  D.P.M.
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
1213ER0200XRadiology PodiatristRHC116746CA
2213ES0103XFoot & Ankle Surgery PodiatristE2603CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1756480842OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3170924000OTHERUS DEPARTMENT OF LABOR

General Provider Information

NPI Number : 1548336605
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER FRANCIS D'COSTA D.P.M.
Provider Business Mailing Address
First Line : 2281 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2905
Country : US
Telephone Number : 707-544-3337
Fax Number : 707-544-0608
Provider Business Practice Location Address
First Line : 2281 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2905
Country : US
Telephone Number : 707-544-3337
Fax Number : 707-544-0608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 08/01/2012

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