Healthcare Provider Details

I. General information

NPI: 1346448578
Provider Name (Legal Business Name): JAMES JACOB WALKER MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

IV. Provider business mailing address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-1941
  • Fax: 724-773-8370
Mailing address:
  • Phone: 724-773-1941
  • Fax: 724-773-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053019
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: