Provider Demographics
NPI:1417044348
Name:WALKER, LEE WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:WILLIAM
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HIDDEN VALLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6780
Mailing Address - Country:US
Mailing Address - Phone:501-663-6900
Mailing Address - Fax:
Practice Address - Street 1:9600 LILE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6326
Practice Address - Country:US
Practice Address - Phone:501-219-1029
Practice Address - Fax:501-219-1174
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145041002Medicaid
ARF28854Medicare UPIN
AR145041002Medicaid