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Organization
WEATHERFORD PEDIATRICS, P.A.
Active
Organization
WEATHERFORD PEDIATRICS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN GAUNTT WALKER M.D. (PRESIDENT)
(817) 596-7717
Entity
Organization
Contact information
Practice address
712 E ANDERSON ST, SUITE A, WEATHERFORD, TX 76086-5873
(817) 596-7717
(817) 596-7119
Mailing address
712 E ANDERSON ST, SUITE A, WEATHERFORD, TX 76086-5873
(817) 596-7717
(817) 596-7119
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H5445
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120339002
—
TX
01
—
89515Z
BCBS
TX
Enumeration date
01/04/2008
Last updated
01/04/2008
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