Provider Demographics
NPI:1619073574
Name:WALKER, EDWARD STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEPHEN
Last Name:WALKER
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 1:2001 NE 48TH CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4512
Mailing Address - Country:US
Mailing Address - Phone:954-772-9822
Mailing Address - Fax:954-772-9697
Practice Address - Street 1:2001 NE 48TH CT
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4512
Practice Address - Country:US
Practice Address - Phone:954-772-9822
Practice Address - Fax:954-772-9697
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40422207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049482800Medicaid
FLD64676Medicare UPIN
FL94120Medicare PIN