Healthcare Provider Details

I. General information

NPI: 1871574335
Provider Name (Legal Business Name): ROBERT STEPHEN WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

DEPT 86236 PO BOX 950195
LOUISVILLE KY
40295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-7449
  • Fax: 502-933-8323
Mailing address:
  • Phone: 502-636-7449
  • Fax: 502-933-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15556
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: