MEDICARE: JEFFREY WALKER

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	103T00000X	Psychologist	24560	TX

General Provider Information

NPI Number	:	1598960403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WALKER

Provider Business Mailing Address
First Line	:	4749 KINGLET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-4923
Country	:	US
Telephone Number	:	281-686-7075
Fax Number	:	713-729-5072

Provider Business Practice Location Address
First Line	:	4749 KINGLET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-4923
Country	:	US
Telephone Number	:	281-686-7075
Fax Number	:	713-729-5072

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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