Provider Demographics
NPI:1972587269
Name:WALKER, DENNIS J (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:308 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4716
Practice Address - Country:US
Practice Address - Phone:352-726-8353
Practice Address - Fax:352-726-5038
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME47107207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8603474OtherCIGNA
FLME0047107OtherSTATE LICENSE NIMBER
FL035846100Medicaid
FL11319387OtherCAQH
FL659859500OtherMEDICAID GROUP
FL77940OtherMEDICARE GROUP ID
FL060013028OtherMEDICARE RR
FL07921OtherBCBS OF FL
FL77940OtherBCBS OF FL GROUP ID
DECF1416OtherMEDICARE RR GROUP
FLME0047107OtherSTATE LICENSE NIMBER
FL77940OtherMEDICARE GROUP ID