Healthcare Provider Details

I. General information

NPI: 1285754853
Provider Name (Legal Business Name): SUSAN BETH WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 STOCKDALE HWY 120
BAKERSFIELD CA
93311-3622
US

IV. Provider business mailing address

PO BOX 2465
BAKERSFIELD CA
93303-2465
US

V. Phone/Fax

Practice location:
  • Phone: 661-665-7822
  • Fax: 661-665-6724
Mailing address:
  • Phone: 661-665-7822
  • Fax: 661-665-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG60839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: