Healthcare Provider Details

I. General information

NPI: 1174596175
Provider Name (Legal Business Name): BEAU JAMES WALKER TOY MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEAUJAMES WALKER TOY

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 SOUTH TONOPAH DRIVE
LAS VEGAS NV
89106
US

IV. Provider business mailing address

624 SOUTH TONOPAH DRIVE
LAS VEGAS NV
89106
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-9100
  • Fax: 702-685-9991
Mailing address:
  • Phone: 702-436-9100
  • Fax: 702-685-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number8223
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: