Provider Demographics
NPI:1255414975
Name:WALKER, JEFFREY W (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 S MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-8327
Practice Address - Country:US
Practice Address - Phone:765-675-7009
Practice Address - Fax:765-675-3914
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200430110Medicaid
IN000000623509OtherANTHEM
INI17412Medicare UPIN
IN000000623509OtherANTHEM
P00374456Medicare PIN
IN177280B5Medicare PIN
IN200430110Medicaid
IN256870001Medicare PIN