Provider Demographics
NPI:1609833763
Name:WALKUP, ROBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:WALKUP
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 1:7117 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-3761
Mailing Address - Country:US
Mailing Address - Phone:806-441-7445
Mailing Address - Fax:
Practice Address - Street 1:7117 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-3761
Practice Address - Country:US
Practice Address - Phone:806-441-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3177207Q00000X, 207P00000X
CO0054607207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149910509Medicaid
TX0050KHOtherBLUE CROSS BLUE SHIELD
TX101361103OtherFIRSTCARE INDIVIDUAL
TX101361100OtherFIRSTCARE LHC
TX101361100OtherFIRSTCARE LHC
TX8C1064Medicare PIN