Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 106284-0501 | UT |
Y | 222Z00000X | Podiatrist | 106284-0501 | UT |
NPI | 1013905819 |
---|---|
Provider Name | Kevin G Walker |
First Address | Denver, CO 80217-5546 |
Second Address | Ogden, UT 84403-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 18/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480012534 | RR MEDICARE (01) | UT |
U19509 | (02) | UT |