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General NPI Number Information
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NPI Number | 1861439796
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Entity Type | Individual
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Provider Name | GUDRUN STOCK WALKER MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 1 SAINT MARY PL
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City | SHREVEPORT
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State | LA
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Zip | 71101-4343
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Country | US
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Telephone | 318-222-1149
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Fax | 318-425-2335
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Provider Business Mailing Address
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Address Line | PO BOX 44123
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City | SHREVEPORT
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State | LA
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Zip | 71134-4123
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Country | US
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Telephone | 318-222-1149
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Fax | 318-425-2335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD018151
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License Number State | LA
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