Provider Demographics
NPI:1679525463
Name:WALKER, TIMOTHY W (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
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 1:4413 US HWY 331 SOUTH
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435
Mailing Address - Country:US
Mailing Address - Phone:850-951-4556
Mailing Address - Fax:850-951-4527
Practice Address - Street 1:4413 US HWY 331 SOUTH
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435
Practice Address - Country:US
Practice Address - Phone:850-951-4500
Practice Address - Fax:850-951-4527
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51072207P00000X
FL51072207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL059185566OtherBCBS PROVIDER NUMBER
FL04656OtherBCBS PROVIDER NUMBER
FL054964900Medicaid
AL059185521OtherBCBS PROVIDER NUMBER
FL054964900Medicaid
FL04656DMedicare PIN
FLP00300415Medicare PIN
FL04656CMedicare PIN
AL059185521OtherBCBS PROVIDER NUMBER