MEDICARE: JANE WALTER D.P.M., P.A.

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
1	261Q00000X	Clinic/Center	PO1735	FL

General Provider Information

NPI Number	:	1720388580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE WALTER D.P.M., P.A.

Provider Business Mailing Address
First Line	:	11 FLORIDA PARK DR N
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3866
Country	:	US
Telephone Number	:	386-445-4734
Fax Number	:	386-445-8411

Provider Business Practice Location Address
First Line	:	11 FLORIDA PARK DR N
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3866
Country	:	US
Telephone Number	:	386-445-4734
Fax Number	:	386-445-8411

Authorized Official
Title or Position	:	OWNER
Name	:	JANE WALTER
Credential	:	D.P.M.
Telephone Number	:	386-445-4734

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	04/22/2013

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