Healthcare Provider Details

I. General information

NPI: 1568577013
Provider Name (Legal Business Name): WALKER P MCVEA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12236 WOODVILLE ST
CLINTON LA
70722
US

IV. Provider business mailing address

PO BOX 96 12236 WOODVILLE ST
CLINTON LA
70722
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-3384
  • Fax: 225-683-3353
Mailing address:
  • Phone: 225-683-3384
  • Fax: 225-683-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2848
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: