Healthcare Provider Details

I. General information

NPI: 1538190442
Provider Name (Legal Business Name): RANDOLPH T. WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

IV. Provider business mailing address

PO BOX 227278
DALLAS TX
75222-7278
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-7777
  • Fax: 214-947-7525
Mailing address:
  • Phone: 972-283-8000
  • Fax: 972-283-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH6684
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: