Provider Demographics
NPI:1336286160
Name:WALKER, KEVIN OLIVER (IDC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:OLIVER
Last Name:WALKER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 STOCKTON ROAD
Mailing Address - Street 2:BLD 624
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106
Mailing Address - Country:US
Mailing Address - Phone:619-524-4450
Mailing Address - Fax:
Practice Address - Street 1:2650 STOCKTON ROAD
Practice Address - Street 2:BLD 624
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106
Practice Address - Country:US
Practice Address - Phone:619-524-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider