Provider Demographics
NPI:1033305602
Name:WALKER, JOHN W T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W T
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14623 HAWTHORNE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1500
Mailing Address - Country:US
Mailing Address - Phone:424-675-4965
Mailing Address - Fax:424-675-4147
Practice Address - Street 1:14623 HAWTHORNE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1500
Practice Address - Country:US
Practice Address - Phone:424-675-4965
Practice Address - Fax:424-675-4147
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA92111207Q00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A921110Medicaid
CA00A921110Medicare PIN