Basic Information
| Provider Information | |||||||||
| NPI: | 1063419554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5590 KIETZKE LN | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895113019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753232080 | ||||||||
| FaxNumber: | 7753252334 | ||||||||
| Practice Location | |||||||||
| Address1: | 5590 KIETZKE LN | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895113019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753232080 | ||||||||
| FaxNumber: | 7753252334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 09/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 3369 | NV | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 002016247 | 05 | NV | MEDICAID | CC3369 | 01 | NV | BLUE CROSS BLUE SHIELD | OTHER | 880167036A012 | 01 | NV | TRICARE | OTHER | FS49001151 | 05 | CA | MEDICAID |