Provider Demographics
NPI:1194724039
Name:WALKER, JARET DALE (DPM)
Entity type:Individual
Prefix:DR
First Name:JARET
Middle Name:DALE
Last Name:WALKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 MEDPARK DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6932
Mailing Address - Country:US
Mailing Address - Phone:940-382-8400
Mailing Address - Fax:800-345-5821
Practice Address - Street 1:3205 MEDPARK
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6932
Practice Address - Country:US
Practice Address - Phone:940-382-8400
Practice Address - Fax:800-345-5821
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1685213E00000X
AR219213E00000X
OK248213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0396Medicare PIN
TXV05504Medicare UPIN