MEDICARE: DIANE WALKER 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	207P00000X	Emergency Medicine Physician	ME0047108	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00096973	OTHER	FL	RAILROAD MCR
3	04488	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1790880326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE WALKER MD

Provider Business Mailing Address
First Line	:	23708 NW 194TH DR
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-7022
Country	:	US
Telephone Number	:	386-454-2270
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 NE 241 ST
Second Line	:
City	:	CROSS CITY
State	:	FL
Zip	:	32628-3305
Country	:	US
Telephone Number	:	352-498-1360
Fax Number	:	352-498-1359

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	05/06/2010

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1558321521 — FLORIDA DEPARTMENT OF HEALTH
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1285694158 — MR. JOHN CLIFFORD KNIGHT PHYSICIANS ASSISTANT
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1366762528 — DR. MATTHEW DANE WALKER D.M.D.
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Directions to “ DIANE WALKER MD” Practice Location

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