Provider Demographics
NPI:1114999562
Name:WALKER, TIMOTHY ELLIS (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ELLIS
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 1:6116 E ARBOR AVE
Mailing Address - Street 2:BUILDING 2 SUITE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6107
Mailing Address - Country:US
Mailing Address - Phone:480-926-3353
Mailing Address - Fax:480-926-3362
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:BUILDING 2 SUITE 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6107
Practice Address - Country:US
Practice Address - Phone:480-926-3353
Practice Address - Fax:480-926-3362
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249864OtherAHCCS ID
D37796Medicare UPIN
AZ71896Medicare ID - Type Unspecified