Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 00201791 | CO |
NPI | 1003162728 |
---|---|
Provider Name | Dr. Marcus James Walker |
First Address | Lakewood, CO 80226-2786 |
Second Address | Lakewood, CO 80227-5122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 31/07/2012 |