Provider Demographics
NPI:1134226590
Name:WALKER, RONALD RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAYMOND
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457-0713
Mailing Address - Country:US
Mailing Address - Phone:707-995-3011
Mailing Address - Fax:707-995-3019
Practice Address - Street 1:16250 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457-0713
Practice Address - Country:US
Practice Address - Phone:707-995-3011
Practice Address - Fax:707-995-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51470208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G514700OtherBLUE SHIELD NUMBER
CA00G514700Medicaid
CA00G514700Medicaid
CAA52000Medicare UPIN