1558329474 NPI number — DR. FRANK STEPHENS WALKER JR. M.D.

Table of content: DR. FRANK STEPHENS WALKER JR. M.D. (NPI 1558329474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558329474 NPI number — DR. FRANK STEPHENS WALKER JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
FRANK
Provider Middle Name:
STEPHENS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1558329474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1740
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77351-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-240-9339
Provider Business Mailing Address Fax Number:
281-361-3993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 BYPASS LN
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77351-7380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-240-9339
Provider Business Practice Location Address Fax Number:
281-361-3993
Provider Enumeration Date:
05/02/2006

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: 208600000X , with the licence number:  MD2022-1357 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: H0912 , 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: 82377Z . This is a "BLUECROSS PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3286839 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 033479901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64106331 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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