Provider Demographics
NPI:1457315814
Name:WALKER, ROBERT B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
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 1:659 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1313
Mailing Address - Country:US
Mailing Address - Phone:304-691-6878
Mailing Address - Fax:304-691-6357
Practice Address - Street 1:663 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1313
Practice Address - Country:US
Practice Address - Phone:304-691-6878
Practice Address - Fax:304-691-5743
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10652207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000194939OtherBC/BS
WV0056287000Medicaid
WV080064997OtherRR MEDICARE
WV080057239OtherRR MEDICARE
OH0439770Medicaid
KY64694078Medicaid
WV2016141Medicare PIN
WV511852Medicare PIN
WV080064997OtherRR MEDICARE
KY64694078Medicaid