Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4410 | NE |
NPI | 1043362742 |
---|---|
Provider Name | James A Walker |
First Address | Lincoln, NE 68506-1571 |
Second Address | Lincoln, NE 68506-1571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47059333613 | (05) | NE |