Healthcare Provider Details

I. General information

NPI: 1154316164
Provider Name (Legal Business Name): PHILLIP ADRIAN WALKER II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WOOD ST
CLARION PA
16214-1336
US

IV. Provider business mailing address

420 WOOD ST
CLARION PA
16214-1336
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-7722
  • Fax: 814-227-2390
Mailing address:
  • Phone: 814-226-7722
  • Fax: 814-227-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS-006335E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0010935320002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: