Provider Demographics
NPI:1730185752
Name:WALKER, RANDY DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:DEAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-0740
Mailing Address - Country:US
Mailing Address - Phone:870-584-3000
Mailing Address - Fax:870-584-3003
Practice Address - Street 1:1553 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3801
Practice Address - Country:US
Practice Address - Phone:870-584-3000
Practice Address - Fax:870-584-3003
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145640002Medicaid
AR145639001Medicaid
ARH44955Medicare UPIN
AR5L991Medicare PIN