Provider Demographics
NPI:1003877069
Name:WALKER, R. KENT (MD)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:KENT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1832
Mailing Address - Country:US
Mailing Address - Phone:903-593-2539
Mailing Address - Fax:903-593-0559
Practice Address - Street 1:627 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1832
Practice Address - Country:US
Practice Address - Phone:903-593-2539
Practice Address - Fax:903-593-0559
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH66832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125629901Medicaid
F43039Medicare UPIN