Provider Demographics
NPI:1861804544
Name:WALTER R EARNEST, DPM
Entity type:Organization
Organization Name:WALTER R EARNEST, DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-782-6382
Mailing Address - Street 1:2751 CORAL REEF WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5733
Mailing Address - Country:US
Mailing Address - Phone:407-782-6382
Mailing Address - Fax:
Practice Address - Street 1:2751 CORAL REEF WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5733
Practice Address - Country:US
Practice Address - Phone:407-782-6382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1229320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities