Provider Demographics
NPI:1437561537
Name:WALKER, LAURA (DPM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MEGORDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:310 S HALCYON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3863
Mailing Address - Country:US
Mailing Address - Phone:805-481-0881
Mailing Address - Fax:805-481-0835
Practice Address - Street 1:2342 PROFESSIONAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1659
Practice Address - Country:US
Practice Address - Phone:805-928-5645
Practice Address - Fax:805-739-1139
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ855213E00000X
CAE5521213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist