Provider Demographics
NPI:1124332200
Name:EDWARDS, WALKER T (DO)
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:T
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1784
Mailing Address - Country:US
Mailing Address - Phone:270-796-6540
Mailing Address - Fax:270-796-6576
Practice Address - Street 1:250 PARK STREET
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1784
Practice Address - Country:US
Practice Address - Phone:270-796-6540
Practice Address - Fax:270-796-6576
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1812714207R00000X
KYTP479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine