Provider Demographics
NPI:1154371821
Name:WALKER, DENNIS MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MARTIN
Last Name:WALKER
Suffix:
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 1:3700 BURGOYNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2608
Mailing Address - Country:US
Mailing Address - Phone:337-474-4291
Mailing Address - Fax:
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8991
Practice Address - Country:US
Practice Address - Phone:337-494-4941
Practice Address - Fax:337-494-4707
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05013R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300373Medicaid
LAP00450891OtherRAILROAD MCR
LA05013ROtherSTATE LICENSE
LA05013ROtherSTATE LICENSE
LA1300373Medicaid
LAP00450891OtherRAILROAD MCR
LA$$$$$$$$$BOtherBCBS
LA5BC61Medicare PIN