MEDICARE: MR. WILLIAM BRADBURY WALKER 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
1	363AM0700X	Medical Physician Assistant	PA9100985	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970010568	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1427039650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM BRADBURY WALKER PA-C

Provider Business Mailing Address
First Line	:	1536 N JEFFERSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6525
Country	:	US
Telephone Number	:	904-475-6319
Fax Number	:	904-475-5809

Provider Business Practice Location Address
First Line	:	1536 N JEFFERSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6525
Country	:	US
Telephone Number	:	904-475-6319
Fax Number	:	904-475-5809

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

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	12/03/2019

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