Healthcare Provider Details

I. General information

NPI: 1699108316
Provider Name (Legal Business Name): STEVEN M. WALKER OPA-C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MILLER RD
ROWLETT TX
75088-5604
US

IV. Provider business mailing address

PO BOX 938
ROWLETT TX
75030-0938
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-699-4418
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-699-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number749TX
License Number StateTX

VIII. Authorized Official

Name: STEVEN M WALKER
Title or Position: SURGICAL ASSISTANT
Credential: OPA-C
Phone: 214-227-2457