Healthcare Provider Details

I. General information

NPI: 1720342108
Provider Name (Legal Business Name): LEE WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BRUNSON DR
TUPELO MS
38801-4947
US

IV. Provider business mailing address

2500 N STATE ST DEPT. OF OPHTHALMOLOGY
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-7211
  • Fax: 662-844-7211
Mailing address:
  • Phone: 601-984-5023
  • Fax: 601-815-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number23881
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberT2617
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: