MEDICARE: DR. MARK WALKER MD

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	207Q00000X	Family Medicine Physician	ME51671	FL

General Provider Information

NPI Number	:	1588653760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WALKER MD

Provider Business Mailing Address
First Line	:	12685 HICKORY RD
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NW 7TH AVE
Second Line	:	PHOENIX EMERGENCY MEDICINE OF BROWARD, LLC
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-9026
Country	:	US
Telephone Number	:	954-759-6789
Fax Number	:

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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