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NPI Code Detail

MEDICARE: DR. GORDON R. WALKER JR. PH.D.

MEDICARE: DR. GORDON R. WALKER JR. PH.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
1103TC0700XClinical Psychologist0810002339VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00159187OTHERVARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2085796OTHERVASENTARA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4090961OTHERVAANTHEM
5090944OTHERVAANTHEM F&A

General Provider Information

NPI Number : 1568547081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON R. WALKER JR. PH.D.
Provider Business Mailing Address
First Line : 804 MOOREFIELD PARK DR
Second Line : SUITE 201
City : NORTH CHESTERFIELD
State : VA
Zip : 23236-3670
Country : US
Telephone Number : 804-560-4640
Fax Number : 804-560-4813
Provider Business Practice Location Address
First Line : 804 MOOREFIELD PARK DR
Second Line : SUITE 201
City : NORTH CHESTERFIELD
State : VA
Zip : 23236-3670
Country : US
Telephone Number : 804-560-4640
Fax Number : 804-560-4813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 05/21/2015

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