Healthcare Provider Details

I. General information

NPI: 1093811465
Provider Name (Legal Business Name): JESSE FRANK WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N. COLLEGE AVE.
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

2783 N. BOXWOOD DR.
FAYETTEVILLE AR
72703
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-5016
  • Fax:
Mailing address:
  • Phone: 479-571-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF7278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: