Provider Demographics
NPI:1962553396
Name:LAMPETER, WALTER ROBERT (CSA)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ROBERT
Last Name:LAMPETER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W HYDE PARK PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2343
Mailing Address - Country:US
Mailing Address - Phone:917-837-9908
Mailing Address - Fax:
Practice Address - Street 1:204 W HYDE PARK PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2343
Practice Address - Country:US
Practice Address - Phone:917-837-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0115174400000X, 174400000X
246ZC0007X
CT090647163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant