Provider Demographics
NPI:1265483705
Name:WALKER, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5168
Mailing Address - Country:US
Mailing Address - Phone:386-677-5351
Mailing Address - Fax:386-673-2787
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5168
Practice Address - Country:US
Practice Address - Phone:386-677-5351
Practice Address - Fax:386-673-2787
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0022583207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038677400Medicaid
FL16963Medicare PIN
FL038677400Medicaid