Provider Demographics
NPI:1205948775
Name:WALKER, JOHN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:PATRICK
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-0481
Mailing Address - Country:US
Mailing Address - Phone:936-544-7757
Mailing Address - Fax:
Practice Address - Street 1:200 RENAISSANCE WAY SUITE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1814
Practice Address - Country:US
Practice Address - Phone:936-544-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035486201Medicaid
TX00QK51OtherMEDICARE ID - TYPE UNSPECIFIED
TX035486201Medicaid