Healthcare Provider Details

I. General information

NPI: 1013227321
Provider Name (Legal Business Name): WILLIAM ROBERT WALKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SOUTH 7650 EAST ROAD
CROW AGENCY MT
59022-0009
US

IV. Provider business mailing address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-2626
  • Fax: 406-638-3572
Mailing address:
  • Phone: 207-288-5081
  • Fax: 207-288-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number638
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1676
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: