Basic Information
| Provider Information | |||||||||
| NPI: | 1184185456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | JEFFREY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 98TH ST STE 4 | ||||||||
| Address2: | STE 4-135 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794233847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063362705 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1610 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794012622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067652611 | ||||||||
| FaxNumber: | 8067652637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | T6747 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.