Provider Demographics
NPI:1003083205
Name:MAY, WALKER
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:
Last Name:MAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S SPRUCE ST
Mailing Address - Street 2:NCMC MEDICAL AND SURGICAL CLINIC
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3100
Mailing Address - Country:US
Mailing Address - Phone:318-375-3239
Mailing Address - Fax:318-375-2755
Practice Address - Street 1:1003 S SPRUCE ST
Practice Address - Street 2:NCMC MEDICAL AND SURGICAL CLINIC
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3100
Practice Address - Country:US
Practice Address - Phone:318-375-3239
Practice Address - Fax:318-375-2755
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038130Medicaid
LA06227Medicaid
LA1062278Medicaid
5D072Medicare PIN
LA1062278Medicaid
193476Medicare Oscar/Certification