Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4001754-15 | WI |
NPI | 1053641126 |
---|---|
Provider Name | Jerry W Walker |
First Address | Milwaukee, WI 53217-4663 |
Second Address | Milwaukee, WI 53217-4663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 12/01/2010 |