Healthcare Provider Details

I. General information

NPI: 1649284829
Provider Name (Legal Business Name): JOHN DAVID WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

PO BOX 8432
KALISPELL MT
59904-1432
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-1789
  • Fax: 406-751-5776
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7479
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: