Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D008701 | AZ |
NPI | 1134449481 |
---|---|
Provider Name | Dr. Todd W Walker |
First Address | Prescott, AZ 86305-7185 |
Second Address | Prescott, AZ 86305-7151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 13/07/2020 |