Provider Demographics
NPI:1285822338
Name:BEVERLY THIR WALKER, MD, PA
Entity Type:Organization
Organization Name:BEVERLY THIR WALKER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-420-3565
Mailing Address - Street 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:281-420-3565
Mailing Address - Fax:281-427-7808
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 309
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3153
Practice Address - Country:US
Practice Address - Phone:281-420-3565
Practice Address - Fax:281-427-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3238Medicare PIN
TX8B5810Medicare PIN
TX8F2777Medicare PIN
TX00W398Medicare PIN