Provider Demographics
NPI:1548277387
Name:WALKER, SCOTT W (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
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 1:147 WATERGATE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE LURE
Mailing Address - State:NC
Mailing Address - Zip Code:28746-9615
Mailing Address - Country:US
Mailing Address - Phone:765-284-7738
Mailing Address - Fax:765-284-4266
Practice Address - Street 1:3331 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031536A207X00000X
NC2017-00112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100341070Medicaid
IN200018967OtherRAILROAD MEDICARE
IN000000087014OtherANTHEM PIN
INC24624Medicare UPIN
IN100341070Medicaid