Provider Demographics
NPI:1568606531
Name:DESMAR WALKES MD PA
Entity Type:Organization
Organization Name:DESMAR WALKES MD PA
Other - Org Name:A PLUS LIFESTYLE MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DESMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-321-1098
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-1979
Mailing Address - Country:US
Mailing Address - Phone:512-321-1098
Mailing Address - Fax:512-303-0885
Practice Address - Street 1:815 HIGHWAY 71 W STE 1150
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-0319
Practice Address - Country:US
Practice Address - Phone:512-321-1098
Practice Address - Fax:512-303-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2887207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
492786OtherJOINT COMMISSION
TXDR8887OtherMEDICARE RAILROAD
TX2865529-01Medicaid
TXTXB121261Medicare Oscar/Certification