Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO 2587 | FL |
NPI | 1205038098 |
---|---|
Provider Name | Paul Lexington Walker |
First Address | Plantation, FL 33317-2039 |
Second Address | Wilton Manors, FL 33311-1726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U63868 | (02) | FL |