MEDICARE: DR. AUSTIN CECIL WALKES 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	207Q00000X	Family Medicine Physician	F2984	TX

General Provider Information

NPI Number	:	1497979819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN CECIL WALKES M.D.

Provider Business Mailing Address
First Line	:	3807 PLATT AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2652
Country	:	US
Telephone Number	:	409-983-2944
Fax Number	:	409-835-8658

Provider Business Practice Location Address
First Line	:	1295 PEARL ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-3642
Country	:	US
Telephone Number	:	409-835-8602
Fax Number	:	409-835-8658

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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