Provider Demographics
NPI:1801250659
Name:WALKER, GREGORY TRENT JR (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:TRENT
Last Name:WALKER
Suffix:JR
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 1:6130 N LA CHOLLA BLVD STE 135A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3557
Mailing Address - Country:US
Mailing Address - Phone:520-881-1394
Mailing Address - Fax:520-882-7464
Practice Address - Street 1:6130 N LA CHOLLA BLVD STE 135A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3557
Practice Address - Country:US
Practice Address - Phone:520-881-1394
Practice Address - Fax:520-882-7464
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ85758207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250013578Medicaid