Healthcare Provider Details

I. General information

NPI: 1457321192
Provider Name (Legal Business Name): WILLIAM WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14336 E MANHEAD LOOKOUT DR
VAIL AZ
85641-2550
US

IV. Provider business mailing address

14336 E MANHEAD LOOKOUT DR
VAIL AZ
85641-2550
US

V. Phone/Fax

Practice location:
  • Phone: 520-975-7083
  • Fax:
Mailing address:
  • Phone: 520-975-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01059020A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: