Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DE00009674 | WA |
Y | 213EG0000X | General Practice | DE00009674 | WA |
NPI | 1003254707 |
---|---|
Provider Name | Mr. Richard R Walker |
First Address | Chehalis, WA 98532 |
Second Address | Chehalis, WA 98532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 05/06/2013 |