Bruce J Walz, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

30961 Issued in MO

Practice address

3635 Vista
St Louis, MO 63110

Phone

(314) 577-8815

Fax

(314) 268-5106

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeast Missouri Hospital Physicians, LLC

  • Family Medicine Physician
  • Cape Girardeau, MO
  • NPI 1558311522
  Medicare reassignment NPD
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199836800000",
    "number": "1063439677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3691 RUTGER AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "314-977-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 VISTA",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "314-577-8815",
            "fax_number": "314-268-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALZ",
        "first_name": "BRUCE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MO",
            "license": "30961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reagan Walton
• Timothy P Walton, MSN, RN, CPNP
• Amanda Nicole Waltos Hieger, MD
• Kaitlyn Michelle Waltsgott
• Shannon Lea Waltsgott, R.PH
• William Walz
• Jennifer Anne Wambach, MD
• Emily Katherine Wambold, PNP
• Anne Wambui, RN
• Amber Joy Wamhoff, RD

• Radiation Oncology Physician in St Louis, MO
• Providers in St Louis, MO by specialty
• Radiation Oncology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.