| Doctor Name: | BRUCE J WALZ |
| NPI Number: | 1063439677 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 30961 |
| Business Practice Address: | 3635 Vista St Louis, MO - 63110 |
| Business Phone Number: | 3145778815 |
| Business Fax Number: | 3142685106 |
| Mailing Address: | 3691 Rutger Ave, Provider Enrollment ST LOUIS |
| State: | MO |
| Postal Code: | 63110 |
| Phone Number: | 3149774440 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 01/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0001X |
| License Number: | 30961 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Radiation Oncology |
| Taxonomy Definition: | A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |