Provider Demographics
NPI:1306895529
Name:WALKER, DAWN KWADER (DO)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:KWADER
Last Name:WALKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:ELLEN
Other - Last Name:KWADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 W REX ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1129
Mailing Address - Country:US
Mailing Address - Phone:520-766-5000
Mailing Address - Fax:520-766-5001
Practice Address - Street 1:801 W REX ALLEN DR
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1129
Practice Address - Country:US
Practice Address - Phone:520-766-5000
Practice Address - Fax:520-766-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ409369Medicaid
AZZ120082Medicare PIN