Healthcare Provider Details

I. General information

NPI: 1174581276
Provider Name (Legal Business Name): ROBERT B WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 442
APO AE
09042
DE

IV. Provider business mailing address

CMR 442
APO AE
09042
DE

V. Phone/Fax

Practice location:
  • Phone: 06221173392
  • Fax:
Mailing address:
  • Phone: 06221173392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2406
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: