Provider Demographics
NPI:1578571816
Name:WALKER, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18540 SIGMA ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3280
Mailing Address - Country:US
Mailing Address - Phone:210-490-4661
Mailing Address - Fax:210-490-4795
Practice Address - Street 1:18540 SIGMA ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3280
Practice Address - Country:US
Practice Address - Phone:210-490-4661
Practice Address - Fax:210-490-4795
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0220207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH57055Medicare UPIN
TX8577B0Medicare ID - Type Unspecified