Healthcare Provider Details

I. General information

NPI: 1215964671
Provider Name (Legal Business Name): JOHN C WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 COLUMBIA POINT DR
RICHLAND WA
99352-4387
US

IV. Provider business mailing address

9725 3RD. AVE NE #500
SEATTE WA
98115-2514
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-0189
  • Fax: 509-946-0264
Mailing address:
  • Phone: 206-527-1200
  • Fax: 206-527-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD00040997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: