Provider Demographics
NPI:1760751648
Name:JOHN PATRICK WALKER MD
Entity Type:Organization
Organization Name:JOHN PATRICK WALKER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-544-7757
Mailing Address - Street 1:200 RENAISSANCE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1772
Mailing Address - Country:US
Mailing Address - Phone:936-544-7757
Mailing Address - Fax:936-545-0952
Practice Address - Street 1:200 RENAISSANCE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1772
Practice Address - Country:US
Practice Address - Phone:936-544-7757
Practice Address - Fax:936-545-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QK5OtherMEDICARE ID
TX035486201Medicaid
TX00QK5OtherMEDICARE ID