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General NPI Number Information
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NPI Number | 1124246525
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Entity Type | Individual
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Provider Name | IVAN LEONARD WALKER PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3020 14TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20009-6865
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Country | US
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Telephone | 202-745-4300
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Fax | 202-232-0723
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Provider Business Mailing Address
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Address Line | 30 FRANKLIN ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1008
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Country | US
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Telephone | 202-588-9320
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Fax | 202-517-9184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA030359
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C03341
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License Number State | MD
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