Provider Demographics
NPI:1649238866
Name:WALKER, JERRY D JR (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:D
Last Name:WALKER
Suffix:JR
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 1:30 N 1900 E
Mailing Address - Street 2:ROOM 4A100 SOM
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132
Mailing Address - Country:US
Mailing Address - Phone:801-585-2341
Mailing Address - Fax:801-587-5874
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:ROOM 4A100 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132
Practice Address - Country:US
Practice Address - Phone:801-585-2341
Practice Address - Fax:801-587-5874
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52929081205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870281028WA1OtherEMIA
UT870281028000Medicaid
UTQM0000067329OtherALTIUS
UTP00100723OtherPALMETTO GBA
UT107017716101OtherIHC HEALTHPLANS
UT72960OtherPEHP
UT802507OtherDMBA
UT25-00402OtherUNITED HEALTHCARE
UT72960OtherPEHP
UT25-00402OtherUNITED HEALTHCARE