MEDICARE: DR. KYLE RUBEN WALKER D.O.

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
1	2085R0202X	Diagnostic Radiology Physician	02002545A	IN
2	2085R0202X	Diagnostic Radiology Physician	M8413	TX

General Provider Information

NPI Number	:	1114917408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE RUBEN WALKER D.O.

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DRIVE
Second Line	:
City	:	JBSA FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-916-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 ROGER BROOKE DRIVE
Second Line	:
City	:	JBSA FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-916-7890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	10/24/2023

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