Individual
WALTER H FORMAN
Active
Individual
WALTER H FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME17928
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054676300
—
FL
01
—
300060057
RAILROAD MEDICARE
FL
01
—
50884
BLUE CROSS BLUE SHIELD
FL
01
—
990105
NEIGHBORHOOD HEALTH
FL
01
—
N272625
WELLCARE
FL
Enumeration date
01/17/2007
Last updated
05/24/2012
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