Individual
MR. WAIDE EDWARD WALKER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
121 TOWNSGATE PLZ, CLOVIS, NM 88101-3714
(575) 742-2620
(575) 742-3182
Mailing address
1008 WEST SPRUCE, PORTALES, NM 88130
(505) 356-8175
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/20/2006
Last updated
09/11/2009
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