Healthcare Provider Details

I. General information

NPI: 1023015906
Provider Name (Legal Business Name): MICHAEL DAVID WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

IV. Provider business mailing address

5305 VICKIE DR
SAN DIEGO CA
92109-1336
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1188
  • Fax: 619-569-3140
Mailing address:
  • Phone: 858-270-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC36377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: