Provider Demographics
NPI:1205017308
Name:WALKER, JONATHAN BAYLESS (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BAYLESS
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 1:3317 S HIGLEY RD STE 114-405
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5459
Mailing Address - Country:US
Mailing Address - Phone:602-263-1508
Mailing Address - Fax:
Practice Address - Street 1:3317 S HIGLEY RD STE 114-405
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-5459
Practice Address - Country:US
Practice Address - Phone:480-452-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine