Healthcare Provider Details

I. General information

NPI: 1750215539
Provider Name (Legal Business Name): ETHAN CHANDLER WALKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S SUTTER DR STE 1
SHOW LOW AZ
85901-8055
US

IV. Provider business mailing address

1961 S BRISTLECONE DR
SHOW LOW AZ
85901-9802
US

V. Phone/Fax

Practice location:
  • Phone: 928-532-7546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: