MEDICARE: CHRISTOPHER MARTIN WALKER IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1104887603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MARTIN WALKER IDC

Provider Business Mailing Address
First Line	:	1972 AQUAMARINE DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1362
Country	:	US
Telephone Number	:	757-282-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS MINNEAPOLIS-ST PAUL (SSN 708)
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09578-2388
Country	:	US
Telephone Number	:	757-534-1756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	07/21/2022

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