Provider Demographics
NPI:1033117973
Name:WALKER, MICHAEL ALAN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HIGHWAY 37 S
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-6597
Mailing Address - Country:US
Mailing Address - Phone:903-537-4548
Mailing Address - Fax:903-537-2596
Practice Address - Street 1:801 HIGHWAY 37 S
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-6597
Practice Address - Country:US
Practice Address - Phone:903-537-4548
Practice Address - Fax:903-537-2596
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041083902Medicaid
TXTXB134052Medicare PIN
TXG90360Medicare UPIN