Provider Demographics
NPI:1568577013
Name:MCVEA, WALKER P (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALKER
Middle Name:P
Last Name:MCVEA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:12236 WOODVILLE ST
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722
Mailing Address - Country:US
Mailing Address - Phone:225-683-3384
Mailing Address - Fax:225-683-3353
Practice Address - Street 1:12236 WOODVILLE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-3384
Practice Address - Fax:225-683-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1828483Medicaid
LAF1242OtherBLUE CROSS BLUE SHIELD