Provider Demographics
NPI:1972668564
Name:ANDREW SCOTT WALKER
Entity Type:Organization
Organization Name:ANDREW SCOTT WALKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-599-7022
Mailing Address - Street 1:937 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5845
Mailing Address - Country:US
Mailing Address - Phone:817-599-7022
Mailing Address - Fax:817-599-6559
Practice Address - Street 1:937 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5845
Practice Address - Country:US
Practice Address - Phone:817-599-7022
Practice Address - Fax:817-599-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020054275OtherMEDICARE RAILROAD
TX1509990-01Medicaid
TX7138381OtherAETNA
TX1670773OtherCIGNA
TX8AJ222OtherBLUE CROSS BLUE SHIELD
TX1509990-01Medicaid
TX1670773OtherCIGNA