Healthcare Provider Details

I. General information

NPI: 1760979801
Provider Name (Legal Business Name): JORDON WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date: 12/30/2021
Reactivation Date: 07/17/2026

III. Provider practice location address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

IV. Provider business mailing address

35 VERNON ST APT 401
BROOKLINE MA
02446-4960
US

V. Phone/Fax

Practice location:
  • Phone: 623-524-4000
  • Fax:
Mailing address:
  • Phone: 713-344-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number275746
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: