Individual
MR. MARK W WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
72459
MN
2084P0800X
Psychiatry Physician
Primary
7585A
WY
2084P0800X
Psychiatry Physician
MD-48932
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72459
STATE MEDICAL LICENSE
MN
01
—
7585A
STATE MEDICAL LICENSE
WY
01
—
MD-48932
STATE MEDICAL LICENSE
IA
Enumeration date
10/24/2006
Last updated
01/23/2025
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