Physician Compare National (NPI:1578856985)

HEALTHCARE PROVIDER: JERRY DON WALKUP JR. M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1578856985
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466676705
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170928004292
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WALKUP
	Individual professional last name
Provider First Name	JERRY
	Individual professional first name
Provider Middle Name	DON
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	PEDIATRIC MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2312 KNOB CREEK RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 208
	Group Practice or individual's line 2 address
City	JOHNSON CITY
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376042367
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y