Provider Demographics
NPI:1336145580
Name:RICHARD F WALKER JR MD NEPHROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:RICHARD F WALKER JR MD NEPHROLOGY ASSOCIATES PA
Other - Org Name:NEPHROLOGY ASSOCIATES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-769-2158
Mailing Address - Street 1:504 N MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3636
Mailing Address - Country:US
Mailing Address - Phone:850-769-2158
Mailing Address - Fax:850-785-9220
Practice Address - Street 1:504 N MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3636
Practice Address - Country:US
Practice Address - Phone:850-769-2158
Practice Address - Fax:850-785-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31955207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060760600Medicaid
C13892OtherRRB PTAN
99506Medicare PIN
C13892OtherRRB PTAN