Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 2534 | TX |
Y | 213ER0200X | Radiology | 2534 | TX |
NPI | 1861461485 |
---|---|
Provider Name | Jerry Don Walker |
First Address | Fort Worth, TX 76107-1221 |
Second Address | Fort Worth, TX 76107-1221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 05/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001062101 | (05) | TX |
T16453 | (02) | TX |