Provider Demographics
NPI:1225014756
Name:WALKER, DANIEL GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GEORGE
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 1:2175 BLAKESLEE BOULEVARD DR W
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9776
Mailing Address - Country:US
Mailing Address - Phone:570-386-4171
Mailing Address - Fax:
Practice Address - Street 1:2175 BLAKESLEE BOULEVARD DR W
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9776
Practice Address - Country:US
Practice Address - Phone:570-386-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014666207Q00000X
KS0530514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200253490DMedicaid
PA102297010Medicaid
PA151709WDBMedicare PIN
KSG53699Medicare UPIN
KS105203Medicare PIN