Provider Demographics
NPI:1083775100
Name:WALKER, CHRISTIAN MICHAEL
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MICHAEL
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 BAYOU BLUE RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3506
Mailing Address - Country:US
Mailing Address - Phone:985-223-2677
Mailing Address - Fax:
Practice Address - Street 1:720 VERRET ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4634
Practice Address - Country:US
Practice Address - Phone:985-868-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice