Provider Demographics
NPI:1801948898
Name:WALKER, JON DAVID (MD ,PSC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD ,PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AUDUBON PLAZA DR
Mailing Address - Street 2:SUITE #450
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1319
Mailing Address - Country:US
Mailing Address - Phone:502-636-0800
Mailing Address - Fax:502-636-0957
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE #450
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-0800
Practice Address - Fax:502-636-0957
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174092086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000244277OtherANTHEM
KY1169724OtherPASSPORT
KY64174097Medicaid
KY000000244277OtherANTHEM
KY1169724OtherPASSPORT