Provider Demographics
NPI:1063412021
Name:WALKER, ROBERT LEO JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEO
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9202
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12634207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000765240OtherBCBS
WV0207026000Medicaid
WV2700052997OtherUHC-MAAC
WV270052997OtherTRI CARE - MAAC
WVDA0096OtherRR MEDICARE
WV0063882000Medicaid
WV270052997Other4-MOST
WV270052997OtherAETNA
WVP00352608OtherRR MEDICARE
WV001706469OtherMSBCBS GROUP
WV27005299700OtherWORKERS COMP
WV270052997002OtherTRICARE
WV0063882000Medicaid
WV270052997OtherAETNA
WVE19487Medicare UPIN
WV000765240OtherBCBS
WVP00352608OtherRR MEDICARE