Provider Demographics
NPI:1861631947
Name:WALKER, JOHN A II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:WALKER
Suffix:II
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:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-4430
Mailing Address - Fax:270-688-4439
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 401
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0878
Practice Address - Country:US
Practice Address - Phone:270-688-4430
Practice Address - Fax:270-688-4439
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47349207Q00000X, 208D00000X
OH35093557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3613031OtherLODI COMMUNITY HOSPITAL GROUP MEDICARE #
OH1003849910OtherLODI COMMUNITY CARE CENTER TYPE 2 NPI #
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #
OH2948958Medicaid
OH2396081OtherLODI COMMUNITY HOSPITAL GROUP MEDICAID #
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #