Provider Demographics
NPI:1366437345
Name:WALTERS, JULIE A (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4410
Mailing Address - Country:US
Mailing Address - Phone:727-372-6760
Mailing Address - Fax:727-372-6808
Practice Address - Street 1:2137 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4410
Practice Address - Country:US
Practice Address - Phone:727-372-6760
Practice Address - Fax:727-372-6808
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161861208000000X
IN01053152A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118096300Medicaid
IN200460910Medicaid
IN354590JMedicare PIN