Basic Information
| Provider Information | |||||||||
| NPI: | 1033117973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 HIGHWAY 37 S | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754576597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035374548 | ||||||||
| FaxNumber: | 9035372596 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 HIGHWAY 37 S | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754576597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035374548 | ||||||||
| FaxNumber: | 9035372596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 09/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K7410 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 041083902 | 05 | TX | MEDICAID |