Provider Demographics
NPI:1154370096
Name:JOYNER, WALTER H (PA)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:H
Last Name:JOYNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:SUITE 101-108
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-253-2169
Mailing Address - Fax:321-253-1720
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:SUITE 101-108
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-253-2169
Practice Address - Fax:321-253-1720
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3396ZMedicare PIN
FLS94462Medicare UPIN