Provider Demographics
NPI:1144290032
Name:WALKER, BRIAN N (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-668-1668
Mailing Address - Fax:731-668-6720
Practice Address - Street 1:322 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-668-1668
Practice Address - Fax:731-668-6720
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17418207RH0003X
TNDO1943207RH0003X
TN01943207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0126632Medicaid
TN3001465Medicaid
30014651Medicare PIN
H77072Medicare UPIN
TN3001465Medicaid