Provider Demographics
NPI:1083802680
Name:WALKER, MONICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 COMMERCIAL CT
Mailing Address - Street 2:STE E
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1651
Mailing Address - Country:US
Mailing Address - Phone:941-486-1404
Mailing Address - Fax:941-486-4146
Practice Address - Street 1:395 COMMERCIAL CT
Practice Address - Street 2:STE E
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1651
Practice Address - Country:US
Practice Address - Phone:941-486-1404
Practice Address - Fax:941-486-4146
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
23614BMedicare PIN
FLE30560Medicare UPIN