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General NPI Number Information
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NPI Number | 1922146240
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Entity Type | Organization
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Legal Business Name | L REED WALKER JR MD INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 12/08/2007
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Provider Practice Location Address
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Address Line | 990 SONOMA AVE SUITE 5
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City | SANTA ROSA
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State | CA
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Zip | 95404-4802
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Country | US
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Telephone | 707-539-9307
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Fax |
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Provider Business Mailing Address
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Address Line | 827 VAUGHN CT
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City | SANTA ROSA
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State | CA
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Zip | 95409-2828
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Country | US
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Telephone | 707-539-9307
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. L REED WALKER JR JR.
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Credential | MD
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Telephone | 707-539-9307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G19285
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License Number State | CA
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