MEDICARE: MUGABE 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	S9079	TX
2	207R00000X	Internal Medicine Physician	S9079	TX
3	207R00000X	Internal Medicine Physician	MT193877	PA
4	207R00000X	Internal Medicine Physician	51132	CO

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

General Provider Information

NPI Number	:	1922304195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUGABE WALKER MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	407-533-6836
Fax Number	:	407-770-0661

Provider Business Practice Location Address
First Line	:	4522 FREDERICKSBURG RD STE A14
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6595
Country	:	US
Telephone Number	:	210-733-3005
Fax Number	:	210-733-3001

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	04/07/2026

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Directions to “ MUGABE WALKER MD” Practice Location

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