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NPI Code Detail

MEDICARE: JIMMY L WALKER JR. PA-C

MEDICARE: JIMMY L WALKER JR. PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363AS0400XSurgical Physician Assistant085002474IL

General Provider Information

NPI Number : 1063472751
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY L WALKER JR. PA-C
Provider Business Mailing Address
First Line : BOX 78534
Second Line :
City : MILWAUKEE
State : WI
Zip : 53278
Country : US
Telephone Number : 815-381-7431
Fax Number : 815-381-7498
Provider Business Practice Location Address
First Line : 324 ROXBURY RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-5090
Country : US
Telephone Number : 815-381-7431
Fax Number : 815-381-7498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2006
Last Update Date : 06/04/2014

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