MEDICARE: THOMAS GERALD WALKER D.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	1223G0001X	General Practice Dentistry	3807	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51531334	OTHER	AL	BCBS
2	430205	OTHER	AL	UNITED CONCORDIA

General Provider Information

NPI Number	:	1629296082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS GERALD WALKER D.M.D.

Provider Business Mailing Address
First Line	:	123 N CHALKVILLE RD
Second Line	:	SUITE # 2
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1376
Country	:	US
Telephone Number	:	205-655-8977
Fax Number	:	205-655-6854

Provider Business Practice Location Address
First Line	:	123 N CHALKVILLE RD
Second Line	:	SUITE # 2
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1376
Country	:	US
Telephone Number	:	205-655-8977
Fax Number	:	205-655-6854

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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