Provider Demographics
NPI:1083693840
Name:WALKER, CHARLES SAMUEL III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SAMUEL
Last Name:WALKER
Suffix:III
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 1:7301 HENNESSY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4384
Mailing Address - Country:US
Mailing Address - Phone:225-766-0050
Mailing Address - Fax:225-766-1499
Practice Address - Street 1:7301 HENNESSY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4384
Practice Address - Country:US
Practice Address - Phone:225-766-0050
Practice Address - Fax:225-766-1499
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014808207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328421Medicaid
LA1328421Medicaid
5J847DD21Medicare PIN
LA5J847Medicare ID - Type Unspecified