Healthcare Provider Details

I. General information

NPI: 1760433601
Provider Name (Legal Business Name): ELOISA S. WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST SUITE 304
BOISE ID
83712-6223
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-9188
  • Fax: 208-336-2636
Mailing address:
  • Phone: 208-337-4254
  • Fax: 208-337-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberM6279
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: