Healthcare Provider Details

I. General information

NPI: 1942354204
Provider Name (Legal Business Name): ROBERT WILLIAM WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEER MOSS TRL
ORMOND BEACH FL
32174-4935
US

IV. Provider business mailing address

4 DEER MOSS TRL
ORMOND BEACH FL
32174-4935
US

V. Phone/Fax

Practice location:
  • Phone: 386-383-2547
  • Fax:
Mailing address:
  • Phone: 386-383-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME43175
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME43175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: