Provider Demographics
NPI:1417103326
Name:WALKER, BRYAN DANIEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DANIEL
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUKE UNIVERSITY MEDICAL CTR
Mailing Address - Street 2:DUMC 3849
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-8615
Mailing Address - Fax:919-681-7936
Practice Address - Street 1:40 MEDICINE CIRCLE
Practice Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:919-684-8615
Practice Address - Fax:919-681-7936
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003685363A00000X
NC001005342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63851Medicare UPIN