Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 3369 | NV |
NPI | 1063419554 |
---|---|
Provider Name | Joseph R Walker |
First Address | Reno, NV 89511-3019 |
Second Address | Reno, NV 89511-3019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 21/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016247 | (05) | NV |
880167036A012 | TRICARE (01) | NV |
C96672 | (02) | NV |
CC3369 | BLUE CROSS BLUE SHIELD (01) | NV |
FS49001151 | (05) | CA |