Provider Demographics
NPI:1003239088
Name:DR. EDWIN WALKER
Entity Type:Organization
Organization Name:DR. EDWIN WALKER
Other - Org Name:DR. EDWIN WALKER MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:HEBERT BUSBY
Authorized Official - Last Name:BIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, CA
Authorized Official - Phone:225-665-5149
Mailing Address - Street 1:8369 FLORIDA BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7862
Mailing Address - Country:US
Mailing Address - Phone:225-665-5149
Mailing Address - Fax:225-667-1770
Practice Address - Street 1:8369 FLORIDA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7862
Practice Address - Country:US
Practice Address - Phone:225-665-5149
Practice Address - Fax:225-667-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208D00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2373978Medicaid
LA5J862Medicare UPIN