Provider Demographics
NPI:1285071449
Name:EDWARD S WALKER MD PA
Entity type:Organization
Organization Name:EDWARD S WALKER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-772-9822
Mailing Address - Street 1:2001 NE 48TH CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4512
Mailing Address - Country:US
Mailing Address - Phone:954-772-9822
Mailing Address - Fax:954-772-9697
Practice Address - Street 1:2001 NE 48TH CT
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4512
Practice Address - Country:US
Practice Address - Phone:954-772-9822
Practice Address - Fax:954-772-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049482800Medicaid
FLD64676Medicare UPIN
FL94120Medicare PIN