Provider Demographics
NPI:1699772186
Name:WALKER, BEVERLY THIER (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:THIER
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CYNDA BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3000
Mailing Address - Country:US
Mailing Address - Phone:281-420-3565
Mailing Address - Fax:281-427-7808
Practice Address - Street 1:4300 CYNDA BROOKE DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3000
Practice Address - Country:US
Practice Address - Phone:281-420-3565
Practice Address - Fax:281-427-7808
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1175812Medicaid
TX8B5946Medicare ID - Type Unspecified
TX1175812Medicaid