Provider Demographics
NPI:1003913120
Name:WALKER, MARSHALL EUGENE (PA)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:EUGENE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5522 WILDOAK DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36206-1360
Mailing Address - Country:US
Mailing Address - Phone:256-235-7521
Mailing Address - Fax:256-235-6129
Practice Address - Street 1:7 FRANKFORD AVE
Practice Address - Street 2:BUIKDING 52 ANNISTON ARMY DEPOT
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4199
Practice Address - Country:US
Practice Address - Phone:256-235-7521
Practice Address - Fax:256-235-6129
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN