Provider Demographics
NPI:1154316164
Name:WALKER, PHILLIP ADRIAN II (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ADRIAN
Last Name:WALKER
Suffix:II
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 1:420 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1336
Mailing Address - Country:US
Mailing Address - Phone:814-226-7722
Mailing Address - Fax:814-227-2390
Practice Address - Street 1:420 WOOD ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1336
Practice Address - Country:US
Practice Address - Phone:814-226-7722
Practice Address - Fax:814-227-2390
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006335E207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010935320002Medicaid
PA412924Medicare PIN
PA0010935320002Medicaid