MEDICARE: DR. RONALD RAYMOND WALKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G51470	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G514700	OTHER	CA	BLUE SHIELD NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134226590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD RAYMOND WALKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 713
Second Line	:
City	:	LOWER LAKE
State	:	CA
Zip	:	95457-0713
Country	:	US
Telephone Number	:	707-995-3011
Fax Number	:	707-995-3019

Provider Business Practice Location Address
First Line	:	16250 MAIN STREET
Second Line	:	SUITE A
City	:	LOWER LAKE
State	:	CA
Zip	:	95457-0713
Country	:	US
Telephone Number	:	707-995-3011
Fax Number	:	707-995-3019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. RONALD RAYMOND WALKER M.D.” Practice Location

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