MEDICARE: RUSSELL WEED WALKER 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	2084N0400X	Neurology Physician	21699	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952303968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL WEED WALKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27514
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85285-7514
Country	:	US
Telephone Number	:	480-967-6500
Fax Number	:	480-967-6540

Provider Business Practice Location Address
First Line	:	350 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4409
Country	:	US
Telephone Number	:	480-967-6500
Fax Number	:	480-967-6540

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/01/2010

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