Provider Demographics
NPI:1891211595
Name:WALKER, ISAAC BENJAMIN JR
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:BENJAMIN
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ONE MILE RD
Mailing Address - Street 2:
Mailing Address - City:EVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24550-2044
Mailing Address - Country:US
Mailing Address - Phone:434-851-5010
Mailing Address - Fax:
Practice Address - Street 1:745 ONE MILE RD
Practice Address - Street 2:
Practice Address - City:EVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24550-2044
Practice Address - Country:US
Practice Address - Phone:434-851-5010
Practice Address - Fax:434-821-1823
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60707149172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver