Provider Demographics
NPI:1205910643
Name:WALTER, MARK W (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:WALTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 3011
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3011
Mailing Address - Country:US
Mailing Address - Phone:307-688-5000
Mailing Address - Fax:307-688-5074
Practice Address - Street 1:1690 ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3679
Practice Address - Country:US
Practice Address - Phone:563-690-2850
Practice Address - Fax:563-582-5335
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2025-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-489322084P0800X
MN724592084P0800X
WY7585A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAMD-48932OtherSTATE MEDICAL LICENSE
MN72459OtherSTATE MEDICAL LICENSE
WY7585AOtherSTATE MEDICAL LICENSE