Healthcare Provider Details

I. General information

NPI: 1801948898
Provider Name (Legal Business Name): JON DAVID WALKER MD ,PSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 AUDUBON PLAZA DR SUITE #450
LOUISVILLE KY
40217-1319
US

IV. Provider business mailing address

3 AUDUBON PLAZA DR SUITE #450
LOUISVILLE KY
40217-1319
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-0800
  • Fax: 502-636-0957
Mailing address:
  • Phone: 502-636-0800
  • Fax: 502-636-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number17409
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: