Provider Demographics
NPI:1538140587
Name:WALKER, LARRY (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
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 1:810 FRANKLIN ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4310
Mailing Address - Country:US
Mailing Address - Phone:256-881-1160
Mailing Address - Fax:256-533-3171
Practice Address - Street 1:810 FRANKLIN ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4310
Practice Address - Country:US
Practice Address - Phone:256-881-1160
Practice Address - Fax:256-533-3171
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21290207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51502366Medicaid
AL51502366OtherBCBS
AL51502366OtherBCBS
AL51502366Medicaid