Provider Demographics
NPI:1699875872
Name:WALKER, ANGUS DON (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGUS
Middle Name:DON
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 SHILOH RD
Mailing Address - Street 2:STE 801
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2457
Mailing Address - Country:US
Mailing Address - Phone:903-581-6312
Mailing Address - Fax:903-581-0235
Practice Address - Street 1:1810 SHILOH RD
Practice Address - Street 2:STE 801
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2457
Practice Address - Country:US
Practice Address - Phone:903-581-6312
Practice Address - Fax:903-581-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P033OtherBCBS PROVIDER NUMBER
TX610006Medicare ID - Type UnspecifiedPROVIDER NUMBER