Healthcare Provider Details

I. General information

NPI: 1932233384
Provider Name (Legal Business Name): ANDREW T. WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 NW FEDERAL HWY
STUART FL
34994-9629
US

IV. Provider business mailing address

1615 NW FEDERAL HWY
STUART FL
34994-9629
US

V. Phone/Fax

Practice location:
  • Phone: 772-878-5858
  • Fax: 772-692-2480
Mailing address:
  • Phone: 772-878-5858
  • Fax: 772-692-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0070441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: