Jaret    Walker    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005108
NPI
1689872046
Tax ID
202390466
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
3205 Medpark Drive
Denton, TX 76208
United States
County
Denton
Phone
9403828400 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address