MEDICARE: MR. SUAVE R WALKER MS

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	106H00000X	Marriage & Family Therapist	IMT 1983	FL

General Provider Information

NPI Number	:	1427459825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUAVE R WALKER MS

Provider Business Mailing Address
First Line	:	1255 SW 101ST TER APT 307
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-5047
Country	:	US
Telephone Number	:	786-663-4389
Fax Number	:

Provider Business Practice Location Address
First Line	:	15100 NW 27TH AVE
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33054-2642
Country	:	US
Telephone Number	:	305-685-8201
Fax Number	:

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

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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