Provider Demographics
NPI:1376599720
Name:WALKER, THOMAS LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4100 HARLANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2035
Mailing Address - Country:US
Mailing Address - Phone:817-924-0412
Mailing Address - Fax:
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-922-6226
Practice Address - Fax:817-922-7071
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2886207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139900822Medicaid
C23074Medicare UPIN
TX8623N5Medicare PIN