Healthcare Provider Details

I. General information

NPI: 1396178604
Provider Name (Legal Business Name): MARK MOORE WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2013
Last Update Date: 08/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CROSSROADS BLVD SUITE 285
CARMEL CA
93923-8674
US

IV. Provider business mailing address

225 CROSSROADS BLVD SUITE 285
CARMEL CA
93923-8674
US

V. Phone/Fax

Practice location:
  • Phone: 831-240-5458
  • Fax:
Mailing address:
  • Phone: 831-240-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC50976
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15751
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: