Healthcare Provider Details

I. General information

NPI: 1881929909
Provider Name (Legal Business Name): JENNIFER MARY WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

379 DIXMYTH AVE 6TH FLOOR, MOHS SURGERY SUITE
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax: 513-246-7590
Mailing address:
  • Phone: 513-246-5732
  • Fax: 513-246-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.122915
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35.122915
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.016124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: