Provider Demographics
NPI:1992735377
Name:WALTER, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:117 FOOTE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6947
Mailing Address - Country:US
Mailing Address - Phone:716-338-9200
Mailing Address - Fax:716-338-9250
Practice Address - Street 1:117 FOOTE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6947
Practice Address - Country:US
Practice Address - Phone:716-338-9200
Practice Address - Fax:716-338-9250
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-02-07
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Provider Licenses
StateLicense IDTaxonomies
NY195224208800000X
PAMD052611L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1518827Medicaid
NY1518827Medicaid
NYF79032Medicare UPIN