Individual
JOLAN E WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 5TH ST S, ACH OUTPATIENT CARE CENTER, ST PETERSBURG, FL 33701-4804
(727) 898-7451
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
233737
MA
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
ME127615
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017059500
—
FL
Enumeration date
10/02/2007
Last updated
10/27/2020
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