Provider Demographics
NPI:1285725408
Name:WALKER, ROGERS SMITH SR (MD)
Entity type:Individual
Prefix:MR
First Name:ROGERS
Middle Name:SMITH
Last Name:WALKER
Suffix:SR
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 1:1300 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-9215
Mailing Address - Country:US
Mailing Address - Phone:843-280-8333
Mailing Address - Fax:843-663-0020
Practice Address - Street 1:1300 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566
Practice Address - Country:US
Practice Address - Phone:843-280-8333
Practice Address - Fax:843-663-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC098806Medicaid
SC098806Medicaid
C81600Medicare UPIN