Healthcare Provider Details

I. General information

NPI: 1962775296
Provider Name (Legal Business Name): WALKER FAMILY MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 S ROCK HOUSE RD
PORTAL AZ
85632-9950
US

IV. Provider business mailing address

801 W REX ALLEN DR
WILLCOX AZ
85643-1129
US

V. Phone/Fax

Practice location:
  • Phone: 520-766-5000
  • Fax:
Mailing address:
  • Phone: 520-766-5000
  • Fax: 520-766-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3240
License Number StateAZ

VIII. Authorized Official

Name: JOE WALKER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 520-766-5000