Healthcare Provider Details

I. General information

NPI: 1194907758
Provider Name (Legal Business Name): WALKER FAMILY MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W REX ALLEN DR
WILLCOX AZ
85643-1136
US

IV. Provider business mailing address

801 W REX ALLEN DR
WILLCOX AZ
85643-1136
US

V. Phone/Fax

Practice location:
  • Phone: 520-766-5000
  • Fax: 520-766-5001
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: WILLIAM JOE WALKER JR.
Title or Position: OFFICE MANAGER
Credential:
Phone: 520-240-2306