Basic Information
Provider Information | |||||||||
NPI: | 1750478731 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WALKER | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | CLINTON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WALKER | ||||||||
OtherFirstName: | J CLINTON | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 10701 NALL AVE | ||||||||
Address2: | SUITE 200 | ||||||||
City: | OVERLAND PARK | ||||||||
State: | KS | ||||||||
PostalCode: | 662111231 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9133815225 | ||||||||
FaxNumber: | 9139010186 | ||||||||
Practice Location | |||||||||
Address1: | 10701 NALL AVE | ||||||||
Address2: | SUITE 200 | ||||||||
City: | OVERLAND PARK | ||||||||
State: | KS | ||||||||
PostalCode: | 662111231 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9133815225 | ||||||||
FaxNumber: | 9139010186 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/09/2006 | ||||||||
LastUpdateDate: | 07/29/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 2008009826 | MO | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0106X | 04-33052 | KS | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
ID | Type | State | Issuer | Description | P00639954 | 01 | KS | RR MEDICARE | OTHER | 04-33052 | 01 | KS | STATE LICENSE | OTHER | 40230013 | 01 | KS | BCBS | OTHER | 2008009826 | 01 | MO | STATE LICENSE | OTHER | P00666804 | 01 | MO | RR MEDICARE | OTHER |