Provider Demographics
NPI:1174597975
Name:WALKER, GARY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1100 N 19TH ST
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2344
Mailing Address - Country:US
Mailing Address - Phone:325-676-8555
Mailing Address - Fax:325-676-1026
Practice Address - Street 1:1100 N 19TH ST
Practice Address - Street 2:SUITE 4D
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2304
Practice Address - Country:US
Practice Address - Phone:325-676-8555
Practice Address - Fax:325-676-1026
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4642208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0894800 02Medicaid
TX00FD14Medicare PIN
TXC23078Medicare UPIN