MEDICARE: DR. JOHN PATRICK 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	208600000X	Surgery Physician	G0254	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00QK51	OTHER	TX	MEDICARE ID - TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205948775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK WALKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 481
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-0481
Country	:	US
Telephone Number	:	936-544-7757
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RENAISSANCE WAY SUITE 100
Second Line	:	SUITE 100
City	:	CROCKETT
State	:	TX
Zip	:	75835-1814
Country	:	US
Telephone Number	:	936-544-7757
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/20/2017

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