Provider Demographics
NPI:1134123607
Name:WALKER, GRACE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:LEE
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 1:476 BUCKEYE ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4079
Mailing Address - Country:US
Mailing Address - Phone:812-232-2683
Mailing Address - Fax:812-877-4620
Practice Address - Street 1:476 BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4079
Practice Address - Country:US
Practice Address - Phone:812-232-2683
Practice Address - Fax:812-877-4620
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01031945OtherPHYSICIAN LICENSE
IN100251460Medicaid
IN1134123607OtherNPI
IN01031945OtherPHYSICIAN LICENSE
IN1134123607OtherNPI