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Walter A Shank JR.

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NPI Number Detailed Information

Provider Information:

Name: Walter A Shank JR.
Gender: M
Provider License Number If Given: 28899

NPI Information:

NPI: 1518966019
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 2101 NICHOLASVILLE RD STE 106
Lexington, KY 40503
Phone Number: 8592785926
Fax Number: 8592763189

Provider Business Practice Location Address:

Address: 2101 NICHOLASVILLE RD STE 106
Lexington, KY 40503
Phone Number: 8592785926
Fax Number: 8592763189

Provider Taxonomy:

Primary: 207R00000X
Secondary (if any):
State: KY

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