Provider Demographics
NPI:1558522987
Name:WALKER, MARC ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROBERT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 COCHRANE CIR # B7500
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-526-7115
Mailing Address - Fax:719-526-7377
Practice Address - Street 1:1650 COCHRANE CIR # B7500
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7115
Practice Address - Fax:719-526-7377
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144623208800000X
HI15535208D00000X
CO0048806208D00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144623OtherSTATE LICENSE