WALKER, SEAN THOMAS (MD)

Provider Demographics

• NPI: 1568758878
• Name: WALKER, SEAN THOMAS (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: SEAN
• Middle Name: THOMAS
• Last Name: WALKER
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 4021 AVENUE B
• Practice Address - City: SCOTTSBLUFF
• Practice Address - State: NE
• Practice Address - Zip Code: 69361-4602
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: Yes
• Enumeration Date: 2011-06-24
• Last Update Date: 2024-03-31

Provider Licenses

State	License ID	Taxonomies
KS	04-39693	2085R0202X
NE	27792	2085R0202X, 2085R0204X
CO	57947	2085R0202X, 2085R0204X
NM		390200000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0204X	Allopathic & Osteopathic Physicians	Radiology	Vascular & Interventional Radiology
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology
No	390200000X	Student, Health Care	Student in an Organized Health Care Education/Training Program

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KS	111257098	Other	MEDICARE PIN
KS	KA3249089	Other	MEDICARE PIN
NE	NA1214114	Other	MEDICARE PIN
CO	561591YQPG	Other	MEDICARE PIN
CO	561591ZLJ3	Other	MEDICARE PIN
NE	NA2517093	Other	MEDICARE PIN
CO	561591YQN9	Other	MEDICARE PIN
CO	561591YQ33	Other	MEDICARE PIN
CO	1568758878	Medicaid
CO	561591YQ3L	Other	MEDICARE PIN
NE	NA1215112	Other	MEDICARE PIN
NE	NA1215112	Other	MEDICARE PIN
NE	NA2517093	Other	MEDICARE PIN
NE	$$$$$$$$$02	Medicaid
NE	$$$$$$$$$07	Medicaid
CO	1568758878	Medicaid
CO	561591YQ3L	Other	MEDICARE PIN
CO	561591YQPG	Other	MEDICARE PIN
CO	561591YQ33	Other	MEDICARE PIN
CO	561591YQN9	Other	MEDICARE PIN
CO	561591YQPG	Medicare PIN
NE	NA1215112	Medicare PIN
CO	561591ZLJ3	Medicare PIN
CO	561591YQ3L	Other	MEDICARE PIN
CO	561591ZLJ3	Other	MEDICARE PIN
NE	$$$$$$$$$03	Medicaid
NE	$$$$$$$$$04	Medicaid
CO	561591YQN9	Other	MEDICARE PIN
KS	111257098	Other	MEDICARE PIN
NE	NA2517093	Medicare PIN