Provider Demographics
NPI:1417281742
Name:WALKER, TAN (DPM)
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3364
Mailing Address - Country:US
Mailing Address - Phone:740-653-2656
Mailing Address - Fax:
Practice Address - Street 1:121 N EWING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3364
Practice Address - Country:US
Practice Address - Phone:740-653-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003267213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3001058Medicaid
OHP00823240Medicare PIN
OH4276071Medicare PIN