Provider Demographics
NPI:1124119730
Name:WALKER, TIMOTHY JAMES (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
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 1:4102 PINION DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5962
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5113207Q00000X
WAMD00024276207Q00000X
CO46667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010000368OtherREGENCE BLUE SHIELD
IDDF615OtherBLUE CROSS
ID002386500OtherHEALTHY CONNECTIONS
ID1118875OtherDMERC
ID002386500Medicaid
WA31251OtherWA LABOR & INDUSTRY
WA8915081OtherCRIME VICTIMS COMPENS
WA1014521Medicaid
ID002386500OtherHEALTHY CONNECTIONS
ID1118875OtherDMERC
ID002386500Medicaid
IDA02809Medicare UPIN