Provider Demographics
NPI:1023085032
Name:WALKER, JON W (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:W
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-683-2338
Mailing Address - Fax:940-683-2394
Practice Address - Street 1:2202 US HIGHWAY 380
Practice Address - Street 2:SUITE 112
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2176
Practice Address - Country:US
Practice Address - Phone:940-683-2338
Practice Address - Fax:940-683-2394
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121005606Medicaid
TX8BZ871OtherBCBS
TX8BZ871OtherBCBS