Provider Demographics
NPI:1558306704
Name:WALKER, MELVIN O (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:O
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 1:2754 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3901
Mailing Address - Country:US
Mailing Address - Phone:417-881-8812
Mailing Address - Fax:417-881-1618
Practice Address - Street 1:2754 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-3901
Practice Address - Country:US
Practice Address - Phone:417-881-8812
Practice Address - Fax:417-881-1618
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
141644OtherHEALTHLINK
22657OtherBCBS
110221088OtherRAILROAD MEDICARE
MO201069747Medicaid
2530OtherCOX HEALTH SYSTEMS
MO201069747Medicaid
002013824Medicare PIN