Provider Demographics
NPI:1881642320
Name:WALKER, DAVID R (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4996
Practice Address - Fax:517-796-6410
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN79450002Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL
MIS74584Medicare UPIN