Provider Demographics
NPI:1114927886
Name:WALTER, RICHARD (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WALTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 WILLOW ST
Mailing Address - Street 2:SUITE 5 B
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4267
Mailing Address - Country:US
Mailing Address - Phone:812-882-2703
Mailing Address - Fax:812-882-2760
Practice Address - Street 1:1813 WILLOW ST
Practice Address - Street 2:SUITE 5 B
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4267
Practice Address - Country:US
Practice Address - Phone:812-882-2703
Practice Address - Fax:812-882-2760
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02000873207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100427420Medicaid
IN000000847454OtherANTHEM
IN000000847454OtherANTHEM
IN258190034Medicare PIN