Provider Demographics
NPI:1639267800
Name:WALKER, JOHN INGRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:INGRAM
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 1:1225 LEAKE ST
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-3715
Mailing Address - Country:US
Mailing Address - Phone:936-825-0314
Mailing Address - Fax:936-825-6423
Practice Address - Street 1:1225 LEAKE ST
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868
Practice Address - Country:US
Practice Address - Phone:936-825-0314
Practice Address - Fax:936-825-6423
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD73562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003EUOtherBCBS
TX123242301Medicaid
TX0003EUOtherBCBS
C23094Medicare UPIN