Provider Demographics
NPI:1487626164
Name:PERROTT, WALTER WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WILLIAM
Last Name:PERROTT
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:PO BOX 919280
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:866-775-5053
Mailing Address - Fax:614-764-9147
Practice Address - Street 1:1000 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6708
Practice Address - Country:US
Practice Address - Phone:866-775-5053
Practice Address - Fax:614-764-9147
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000064942085R0202X
FLME915352085R0202X
KY370752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL107040Medicaid
AL107039Medicaid
AL108515Medicaid
AL108199Medicaid
E61316Medicare UPIN
051522659Medicare PIN
AL107040Medicaid
AL108199Medicaid
000058867Medicare PIN
051522597Medicare PIN
051522589Medicare PIN