Healthcare Provider Details

I. General information

NPI: 1760472203
Provider Name (Legal Business Name): SCOTT A WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN KUSKO CLINIC
BETHEL AK
99559
US

IV. Provider business mailing address

416E MANOR AVE
ANCHORAGE AK
99501-1154
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6300
  • Fax: 907-543-6250
Mailing address:
  • Phone: 907-545-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7366
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: