Healthcare Provider Details

I. General information

NPI: 1023336724
Provider Name (Legal Business Name): MATTHEW SELMAN WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ODONAVAN BLVD STE 404
WALKER LA
70785-6351
US

IV. Provider business mailing address

5000 ODONAVAN BLVD STE 404
WALKER LA
70785-6351
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-5500
  • Fax: 225-369-8140
Mailing address:
  • Phone: 225-765-5500
  • Fax: 225-369-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.205276
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: