Healthcare Provider Details

I. General information

NPI: 1285071449
Provider Name (Legal Business Name): EDWARD S WALKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 NE 48TH CT SUITE 1
FORT LAUDERDALE FL
33308-4512
US

IV. Provider business mailing address

2001 NE 48TH CT SUITE 1
FORT LAUDERDALE FL
33308-4512
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-9822
  • Fax: 954-772-9697
Mailing address:
  • Phone: 954-772-9822
  • Fax: 954-772-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WALKER
Title or Position: MD
Credential:
Phone: 954-772-9822