Provider Demographics
NPI:1124159355
Name:OFFENHARTZ, WALTER (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:OFFENHARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SW CHAMBER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3496
Mailing Address - Country:US
Mailing Address - Phone:772-873-0303
Mailing Address - Fax:772-873-0353
Practice Address - Street 1:140 SW CHAMBER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3496
Practice Address - Country:US
Practice Address - Phone:772-878-0303
Practice Address - Fax:772-878-0353
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00411901Medicare PIN
FLAD726ZMedicare PIN