Provider Demographics
NPI:1497843106
Name:WALKER, WESLEY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ROBERT
Last Name:WALKER
Suffix:
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 1:4299 SAN FELIPE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2916
Mailing Address - Country:US
Mailing Address - Phone:832-476-4900
Mailing Address - Fax:832-476-3990
Practice Address - Street 1:1625 N. GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 425
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3686
Practice Address - Country:US
Practice Address - Phone:703-717-4400
Practice Address - Fax:703-717-4401
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0302207R00000X
VA0101248298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171337201Medicaid
TX171337201Medicaid
VA209405ZCALMedicare PIN
GAP00195464Medicare PIN
TX8D0974Medicare PIN