Individual
PETER WALMY ST LOUIS ANGERVIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1940 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-6123
(928) 459-3512
Mailing address
PO BOX 617, SOMERTON, AZ 85350-0617
(928) 315-7910
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-23-253666
FL
207Q00000X
Family Medicine Physician
1238
PR
363A00000X
Physician Assistant
Primary
9800
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100588329
—
FL
05
—
137583
—
AZ
Enumeration date
03/22/2022
Last updated
08/13/2024
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