Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 018.001878 | IL |
NPI | 1104260314 |
---|---|
Provider Name | Dr. Cameron James Walker |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2013 |
Last Update Date | 10/07/2013 |