Provider Demographics
NPI:1356376891
Name:WALKER, DANIEL RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RICHARD
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VISION PARK BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:936-756-1322
Mailing Address - Fax:936-273-5926
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2888
Practice Address - Country:US
Practice Address - Phone:936-756-1322
Practice Address - Fax:936-756-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0253174400000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4354722OtherAETNA
TX00FQ60OtherBLUE CROSS
TX130523703Medicaid
TX00FQ60OtherBLUE CROSS
TX4354722OtherAETNA