Healthcare Provider Details

I. General information

NPI: 1083619910
Provider Name (Legal Business Name): LAWRENCE R. WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29099 HOSPITAL ROAD SUITE 114
LAKE ARROWHEAD CA
92352
US

IV. Provider business mailing address

1901 W LUGONIA AVE SUITE 230
REDLANDS CA
92374-9703
US

V. Phone/Fax

Practice location:
  • Phone: 909-726-6100
  • Fax: 909-557-1745
Mailing address:
  • Phone: 909-557-1600
  • Fax: 909-557-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC42773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: