Healthcare Provider Details

I. General information

NPI: 1790024925
Provider Name (Legal Business Name): MR. MYLES MILTON WALKER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WALLACE RD
BEDFORD NH
03110-5140
US

IV. Provider business mailing address

164 WALLACE RD
BEDFORD NH
03110-5140
US

V. Phone/Fax

Practice location:
  • Phone: 603-289-1468
  • Fax: 603-472-6957
Mailing address:
  • Phone: 603-289-1468
  • Fax: 603-472-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberH517
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: