JACK RYAN WALTER


Address: 9040 Jackson Ave Mamc Urology, Tacoma, WA 98431
Phone: 2539682300

JACK RYAN WALTER (NPI# 1306879366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1306879366
Entity Type Individual
Full Name JACK RYAN WALTER
Credential MD
Practice Address 9040 Jackson Ave Mamc Urology
Tacoma
WA 98431
Mailing Address 820 N Chelan Ave
Wenatchee
WA 98801-2028
Practice Telephone 2539682300
Mailing Telephone 5096638711
Enumeration Date 2006-07-09
Last Update Date 2019-02-12
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208800000X Urology MD60267047 WA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WA 1306879366 05
WA RR MEDICARE WVH P01715983 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
820 N Chelan Ave, Wenatchee, WA 988012028 5096638711
3124 S 19th St Ste C320, Tacoma, WA 984052485 2533015100

Office Location

Street Address 9040 JACKSON AVE MAMC UROLOGY
City TACOMA
State WA
Zip Code 98431

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1497212260 Catrina Renee Grugin Registered Nurse Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 2019-02-27
1801307681 Bianca Gomez Dental Assistant Bldg 9900 Lincoln Street, Jblm, WA 98431 2017-10-19
1184133225 Darren Paris Registered Nurse Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 2017-09-20
1922538206 Sarah Frerichs Dentist Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 2017-06-19
1740736495 Misty Hill Dental Assistant 9119 Mill Park Ave, Tacoma, WA 98431 2016-08-31
1336695535 Jacqueline D Massouda Dentist Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 2016-08-28
1609239375 Gregg V Palmer Licensed Practical Nurse 17th and C Street, Bldg 11582, Tacoma, WA 98431 2016-03-31
1114323904 Deanna Sheets Nurse Practitioner 911 Mil Park Ave, Tacoma, WA 98431 2014-11-06
1679905434 Austin William Schaar Dentist Building 9900, 2nd Floor, Tacoma, WA 98431 2013-08-05
1518209758 Maurice Ibrahim Khayat Internal Medicine 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 2013-03-26
Find all providers in zip 98431

Taxonomy Information

Taxonomy Code 208800000X
Grouping Allopathic & Osteopathic Physicians
Classification Urology

Taxonomy Definition

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1730447731 Daniel Christian Sackman Urology 3124 South 19th St #c320, Tacoma, WA 98405-3011 2012-04-26
1073886438 Peter John Minich Urology 3124 S 19th St Ste 240, Tacoma, WA 98405-2433 2012-02-15
1780909184 Matthew Michael Banti Urology Urology Service Madigan Army Ctr, 9040 Jackson Ave, Tacoma, WA 98431-1100 2010-03-29
1942436886 Charles Y Chang Urology 3124 S 19th St # 320, Tacoma, WA 98405-2433 2009-06-05
1649442682 Patrick Shannon Mcdonough Urology Madigan Army Medical Center - Bldg 9040, Fitzsimmons Drive, Tacoma, WA 98431-0001 2008-03-31
1063525723 Scott Paul Cuda Urology Madigan Army Medical Center 9040 Jackson Avenu, Tacoma, WA 98431-7282 2006-08-16
1134472798 Carolyn Anne Salter Urology 9040 Jackson Ave, Tacoma, WA 98431-0001 2012-10-19
1477839066 Richard Johnston Urology 1708 Yakima Ave, Suite 310, Tacoma, WA 98405-5307 2011-10-26
1902137763 Franciscan Medical Group Urology 1624 S I St, Ste 204, Tacoma, WA 98405-5016 2010-01-19
1043544224 Franciscan Medical Group Urology 1624 S I St, #204, Tacoma, WA 98405-5016 2009-09-22
Find all providers in TACOMA

Competitor

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City TACOMA
Zip Code 98431

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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