Provider Demographics
NPI:1164700944
Name:CALVIN WALKER MD, LLC
Entity Type:Organization
Organization Name:CALVIN WALKER MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-323-0700
Mailing Address - Street 1:3418 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 24
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2376
Mailing Address - Country:US
Mailing Address - Phone:318-323-0700
Mailing Address - Fax:318-323-9983
Practice Address - Street 1:3418 MEDICAL PARK DR
Practice Address - Street 2:SUITE 24
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2376
Practice Address - Country:US
Practice Address - Phone:318-323-0700
Practice Address - Fax:318-323-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07177R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52284OtherMEDICARE PROVIDER NUMBER
LA1363341Medicaid
LA1363341Medicaid