Provider Demographics
NPI:1609833102
Name:WALKER, MARVIN DEAN (DO)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:DEAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 37TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4303
Mailing Address - Country:US
Mailing Address - Phone:515-277-0753
Mailing Address - Fax:
Practice Address - Street 1:12368 STRATFORD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8162
Practice Address - Country:US
Practice Address - Phone:515-226-9810
Practice Address - Fax:515-226-8408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA022042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1043364Medicaid
IAI4015Medicare ID - Type Unspecified
IA1043364Medicaid