Provider Demographics
NPI:1356309926
Name:WALKER, RICK B (DO)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:B
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 NICHOLS RD
Practice Address - Street 2:SUITE # 3
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3093
Practice Address - Country:US
Practice Address - Phone:573-302-3990
Practice Address - Fax:573-302-2753
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8G91207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO246918726Medicaid
MO246918726Medicaid
F79096Medicare UPIN
MO200036655Medicare PIN
MO5283960001Medicare NSC