Shane A. Walter, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

0I1002X171 Issued in WA

Practice address

BHC Bangor, 2050 Barb St
Suite a, Naval Submarine Base Bangor
Silverdale, WA 98315-2099

Phone

(360) 315-4356

Fax

(360) 396-4247

NPI assigned

Mar 8, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1316915309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 NE SHOREWOOD CT",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983708436",
            "telephone_number": "360-598-5312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BHC BANGOR, 2050 BARB ST",
            "address_2": "SUITE A, NAVAL SUBMARINE BASE BANGOR",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983152099",
            "telephone_number": "360-315-4356",
            "fax_number": "360-396-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "SHANE",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "WA",
            "license": "0I1002X171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Independent Duty Corpsman in Silverdale, WA
• Providers in Silverdale, WA by specialty
• Independent Duty Corpsman in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.