MEDICARE: TOD M 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1942485560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOD M WALKER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1824
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52406-1824
Country	:	US
Telephone Number	:	319-369-4505
Fax Number	:	319-369-4677

Provider Business Practice Location Address
First Line	:	310 HIGHWAY 1 S
Second Line	:
City	:	MOUNT VERNON
State	:	IA
Zip	:	52314-9501
Country	:	US
Telephone Number	:	319-895-9010
Fax Number	:

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	04/24/2008

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Directions to “ TOD M WALKER PA-C” Practice Location

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