1306890058 NPI number — GEOFFREY WALKER MD

Table of content: GEOFFREY WALKER MD (NPI 1306890058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306890058 NPI number — GEOFFREY WALKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
GEOFFREY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306890058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-0132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-358-2300
Provider Business Mailing Address Fax Number:
214-366-6127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2005 W PARK DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75061-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-358-2300
Provider Business Practice Location Address Fax Number:
214-579-6984
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  F5791 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1911275 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8864J1 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 115885901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2323067 . This is a "BCBS BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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