Provider Demographics
NPI:1952309031
Name:WALKER, JONATHAN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12870 HILLCREST RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1531
Mailing Address - Country:US
Mailing Address - Phone:972-991-1153
Mailing Address - Fax:972-991-1346
Practice Address - Street 1:12870 HILLCREST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1531
Practice Address - Country:US
Practice Address - Phone:972-991-1153
Practice Address - Fax:972-991-1346
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD26222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23088Medicare UPIN
TX002944Medicare ID - Type Unspecified