Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | R9B43 | MO |
NPI | 1083784375 |
---|---|
Provider Name | Valerie O Walker |
First Address | Saint Louis, MO 63135-0991 |
Second Address | Bridgeton, MO 63044-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 05/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003138081A | (05) | GA |
201613049 | (05) | MO |
A24306 | (02) | MO |