PETER J WALTON MD PA
Medical Practice at Countryway Blvd, Tampa, FL

License number
Florida ME0073900
Category
Medical Practice
Type
Specialist
Owner
Name: MRS. DANEINE M DURHAM
Title: OFFICE MANAGER
Phone: (813) 854-1919
Address
Address
10933 Countryway Blvd, Tampa, FL 33626
National Provider ID: 1306067616
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PETER J. WALTON, M.D., PA

10933 Countryway Blvd, Tampa, FL 33626

Status:
Inactive
Inactive reason:
Reinstatement
Registration:
Feb 26, 2004
Inactive since:
May 18, 2015
State ID:
P04000037705
Business type:
Florida Profit Corporation
Director:
Peter J Walton Director, inactive, 10933 Countryway Blvd, Tampa, FL 33626 (Physical)
Agent:
Peter Walton,10933 Countryway Blvd, Tampa, FL 33626 (Physical)
EIN:
20-0792402

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