Provider Demographics
NPI:1306843750
Name:DOUGLAS C. WALKER D.O., P.C.
Entity Type:Organization
Organization Name:DOUGLAS C. WALKER D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-257-3684
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-0278
Mailing Address - Country:US
Mailing Address - Phone:435-257-3684
Mailing Address - Fax:435-257-7554
Practice Address - Street 1:300 W 1400 S
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:UT
Practice Address - Zip Code:84312-9393
Practice Address - Country:US
Practice Address - Phone:435-257-3684
Practice Address - Fax:435-257-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3592391204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519969458039Medicaid
UTDG3930Medicare PIN