Healthcare Provider Details

I. General information

NPI: 1477536324
Provider Name (Legal Business Name): JOHN A WALKER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16052 DOCTORS BLVD
HAMMOND LA
70403-1478
US

IV. Provider business mailing address

PO BOX 280
PONCHATOULA LA
70454-0280
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-9606
  • Fax: 985-345-9616
Mailing address:
  • Phone: 985-345-9606
  • Fax: 985-345-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011436
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: