Provider Demographics
NPI:1134278211
Name:RANDALL D. WALKER, M.D., P.A.
Entity Type:Organization
Organization Name:RANDALL D. WALKER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITTELSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-356-2900
Mailing Address - Street 1:827 MAGNOLIA BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8553
Mailing Address - Country:US
Mailing Address - Phone:281-356-2900
Mailing Address - Fax:281-356-5830
Practice Address - Street 1:827 MAGNOLIA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8553
Practice Address - Country:US
Practice Address - Phone:281-356-2900
Practice Address - Fax:281-356-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00262WMedicare PIN
TX00262WMedicare UPIN