MEDICARE: WALKER AND RAYNAL DMD

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	1223G0001X	General Practice Dentistry	DN11892	FL

General Provider Information

NPI Number	:	1144435918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALKER AND RAYNAL DMD

Provider Business Mailing Address
First Line	:	212 N MOON AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-4422
Country	:	US
Telephone Number	:	813-689-5928
Fax Number	:	813-689-2621

Provider Business Practice Location Address
First Line	:	212 N MOON AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-4422
Country	:	US
Telephone Number	:	813-689-5928
Fax Number	:	813-689-2621

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DAVID WALKER
Credential	:	D.M.D.
Telephone Number	:	813-689-5928

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/12/2015

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