Provider Demographics
NPI:1205396397
Name:WALKER, TAMAR VIRTELLE LAN (MD, MBA)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:VIRTELLE LAN
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 SOUTH CONGRESS AVENUE
Mailing Address - Street 2:3 SOUTH
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-548-1711
Mailing Address - Fax:561-548-1743
Practice Address - Street 1:5301 SOUTH CONGRESS AVENUE
Practice Address - Street 2:3 SOUTH
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-548-1711
Practice Address - Fax:561-548-1743
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program