MEDICARE: PAUL A WALKER M.D.

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	207Y00000X	Otolaryngology Physician	043504	GA
2	207Y00000X	Otolaryngology Physician	ME123209	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285627497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL A WALKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 41113
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-1113
Country	:	US
Telephone Number	:	904-202-5111
Fax Number	:	904-391-5836

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY DR
Second Line	:	SUITE 230
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8502
Country	:	US
Telephone Number	:	904-592-1068
Fax Number	:	904-541-4728

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	10/10/2016

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Directions to “ PAUL A WALKER M.D.” Practice Location

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