Provider Demographics
NPI:1124128004
Name:WALEK, STUART A (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:WALEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 679191
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-9191
Mailing Address - Country:US
Mailing Address - Phone:972-316-4555
Mailing Address - Fax:469-802-1548
Practice Address - Street 1:4471 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1755
Practice Address - Country:US
Practice Address - Phone:972-316-4555
Practice Address - Fax:972-316-4550
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5517207N00000X
FLME89667207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI10437Medicare UPIN
FL37808WMedicare ID - Type Unspecified