Healthcare Provider Details

I. General information

NPI: 1982734695
Provider Name (Legal Business Name): BENJAMIN J WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE B6/319 CLINICAL SCIENCES CENTER
MADISON WI
53792-3272
US

IV. Provider business mailing address

600 HIGHLAND AVE B6/319 CLINICAL SCIENCES CENTER DEPT OF ANESTHESIOLOGY
MADISON WI
53792
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8100
  • Fax: 608-263-8111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54790
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number54790
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number60003993
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number54790
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: