1417103326 NPI number — MR. BRYAN DANIEL WALKER P.A.-C.

Table of content: MR. BRYAN DANIEL WALKER P.A.-C. (NPI 1417103326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417103326 NPI number — MR. BRYAN DANIEL WALKER P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
BRYAN
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
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:
1417103326
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DUKE UNIVERSITY MEDICAL CTR
Provider Second Line Business Mailing Address:
DUMC 3849
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-684-8615
Provider Business Mailing Address Fax Number:
919-681-7936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MEDICINE CIRCLE
Provider Second Line Business Practice Location Address:
DUKE UNIVERSITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-8615
Provider Business Practice Location Address Fax Number:
919-681-7936
Provider Enumeration Date:
08/12/2008

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: 363A00000X , with the licence number:  C0003685 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 001005342 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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