Provider Demographics
NPI:1730374901
Name:WALKER, ANN GRAVES (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:GRAVES
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1053
Mailing Address - Country:US
Mailing Address - Phone:818-279-8313
Mailing Address - Fax:
Practice Address - Street 1:1100 N GRAND AVE
Practice Address - Street 2:BLDG. 67B
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1341
Practice Address - Country:US
Practice Address - Phone:909-594-5611
Practice Address - Fax:909-468-3997
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWA656313Medicaid
NJWA656313Medicaid