Provider Demographics
NPI:1902904022
Name:WALKER, ENLOW RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:ENLOW
Middle Name:RAYMOND
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:PO BOX 55918
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-0918
Mailing Address - Country:US
Mailing Address - Phone:907-488-1442
Mailing Address - Fax:907-452-6361
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5930
Practice Address - Country:US
Practice Address - Phone:907-452-1761
Practice Address - Fax:907-452-6361
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA3094AK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3094Medicaid
AKMD3094Medicaid