Provider Demographics
NPI:1255685152
Name:WALKER, SAMUEL PATRICK JR (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PATRICK
Last Name:WALKER
Suffix:JR
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 1:1305 DAIRY LN
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9764
Mailing Address - Country:US
Mailing Address - Phone:205-454-7704
Mailing Address - Fax:
Practice Address - Street 1:1305 DAIRY LN
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9764
Practice Address - Country:US
Practice Address - Phone:205-454-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1545207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program