MEDICARE: MARK STEPHEN WALMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	15974	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z62340	OTHER	AZ	MEDICARE Z62340

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629166053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK STEPHEN WALMER MD

Provider Business Mailing Address
First Line	:	655 S DOBSON RD
Second Line	:	A201
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5669
Country	:	US
Telephone Number	:	480-821-3821
Fax Number	:	186-677-7239

Provider Business Practice Location Address
First Line	:	655 S DOBSON RD
Second Line	:	A201
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5669
Country	:	US
Telephone Number	:	480-821-3821
Fax Number	:	186-677-7239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/16/2011

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