Provider Demographics
NPI:1306143029
Name:WALKER, JEFF P (CST)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:P
Last Name:WALKER
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9499 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7150
Mailing Address - Country:US
Mailing Address - Phone:702-933-9600
Mailing Address - Fax:702-933-9601
Practice Address - Street 1:9499 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7150
Practice Address - Country:US
Practice Address - Phone:702-933-9600
Practice Address - Fax:702-933-9601
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV116885246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist