Healthcare Provider Details

I. General information

NPI: 1962666388
Provider Name (Legal Business Name): IAN G. WALKER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 11/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N TEJON ST
COLORADO SPRINGS CO
80907-6231
US

IV. Provider business mailing address

2727 N TEJON ST
COLORADO SPRINGS CO
80907-6231
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-1818
  • Fax: 719-632-4615
Mailing address:
  • Phone: 719-632-1818
  • Fax: 719-632-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN G WALKER
Title or Position: OWNER
Credential: MD
Phone: 719-632-1818