Provider Demographics
NPI:1407888118
Name:WALKER, SHAWN T K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:T K
Last Name:WALKER
Suffix:
Gender:M
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:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0746
Mailing Address - Country:US
Mailing Address - Phone:701-452-2919
Mailing Address - Fax:
Practice Address - Street 1:1015 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-0617
Practice Address - Country:US
Practice Address - Phone:701-452-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13437OtherBSND @ WSK
ND18595Medicaid
ND5166Medicaid
ND13443OtherBSND @ GACKLE
ND13439OtherBSND @ KULM
ND13444OtherBSND @ NAPOLEON
ND18594Medicaid
ND1010985OtherPREFERRED ONE
ND5085Medicaid
ND1320584OtherAMERICA'S PPO
ND5028Medicaid
ND5063Medicaid
ND18595Medicaid
ND13443OtherBSND @ GACKLE
NDN13437Medicare ID - Type Unspecified
ND353408Medicare ID - Type Unspecified
ND5028Medicaid
NDG11088Medicare UPIN