Provider Demographics
NPI:1831288471
Name:WALKER, REBECCA L (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
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:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4471
Mailing Address - Fax:682-885-3939
Practice Address - Street 1:6316 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2766
Practice Address - Country:US
Practice Address - Phone:817-605-2504
Practice Address - Fax:817-605-2505
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125290007Medicaid
TX0003GSOtherBCBSTX GRP PIN
TX124068OtherSUPERIOR PIN
TX1416131OtherFIRSTHEALTH PIN
TX125290004Medicaid
TX170994101Medicaid
TX8Z1880OtherBCBSTX IND PIN
TX163314101Medicaid
1124098447OtherGRP NPI NUMBER
TX125290008Medicaid
TX4057626OtherAETNA PIN
TX080626701Medicaid
TX163314101Medicaid