Individual
DR. WALTER DAVID KISTLER JR.
Active
Individual
DR. WALTER DAVID KISTLER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R3878
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000003759
PTAN
MO
01
—
178790
BLUE CROSS BLUE SHIELD
MO
01
—
186857
GHP
MO
05
—
200690907
—
MO
01
—
431059684
FED TAX ID
—
01
—
P00174135
RAILROAD MEDICARE
—
Enumeration date
07/07/2005
Last updated
05/11/2015
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