Provider Demographics
NPI:1982880357
Name:WALKER, RICHARD WENDELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WENDELL
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 1:4604 HISPANIA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1487
Mailing Address - Country:US
Mailing Address - Phone:832-622-1624
Mailing Address - Fax:
Practice Address - Street 1:4604 HISPANIA VIEW DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1487
Practice Address - Country:US
Practice Address - Phone:832-622-1624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184844207Q00000X
TXG06412083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1287658-07Medicaid
TX6165N6586AOtherAETNA