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General NPI Number Information
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NPI Number | 1962775296
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Entity Type | Organization
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Legal Business Name | WALKER FAMILY MEDICINE PLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 2391 S ROCK HOUSE RD
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City | PORTAL
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State | AZ
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Zip | 85632-9950
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Country | US
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Telephone | 520-766-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 801 W REX ALLEN DR
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City | WILLCOX
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State | AZ
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Zip | 85643-1129
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Country | US
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Telephone | 520-766-5000
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Fax | 520-766-5001
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JOE WALKER
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Credential |
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Telephone | 520-766-5000
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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 | 3240
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License Number State | AZ
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