Healthcare Provider Details

I. General information

NPI: 1447381629
Provider Name (Legal Business Name): MICHAEL R WALKER ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6702 W POLY WEBB RD
ARLINGTON TX
76016-3615
US

IV. Provider business mailing address

6702 W POLY WEBB RD
ARLINGTON TX
76016-3615
US

V. Phone/Fax

Practice location:
  • Phone: 817-478-0095
  • Fax: 817-478-2768
Mailing address:
  • Phone: 817-478-0095
  • Fax: 817-478-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number22674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: