Provider Demographics
NPI:1588685432
Name:TIMOTHY E WALKER MDPC
Entity Type:Organization
Organization Name:TIMOTHY E WALKER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:480-926-3353
Mailing Address - Street 1:6116 EAST ARBOR AVE
Mailing Address - Street 2:BUILDING 2 #106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-926-3353
Mailing Address - Fax:480-926-3362
Practice Address - Street 1:6116 EAST ARBOR AVE
Practice Address - Street 2:BUILDING 2 #106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-926-3353
Practice Address - Fax:480-926-3362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71895Medicare ID - Type UnspecifiedGROUP
AZ71896Medicare ID - Type UnspecifiedPROVIDER
AZD37796Medicare UPIN