Provider Demographics
NPI:1548270754
Name:WALKER, EARL A (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:A
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 1:85 MCNAUGHTEN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2174
Mailing Address - Country:US
Mailing Address - Phone:614-863-1611
Mailing Address - Fax:614-863-1614
Practice Address - Street 1:85 MCNAUGHTEN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2174
Practice Address - Country:US
Practice Address - Phone:614-863-1611
Practice Address - Fax:614-863-1614
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35041285207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457901Medicaid
OHB96586Medicare UPIN
OHWA0500903Medicare ID - Type Unspecified