Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 1456 | SC |
NPI | 1487768206 |
---|---|
Provider Name | Dr. Walter Keith Walker |
First Address | Greenville, SC 29607-2414 |
Second Address | Greenville, SC 29607-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZX1456 | (05) | SC |