Provider Demographics
NPI:1619949617
Name:WALKER, BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 GOLD HILL RD
Practice Address - Street 2:STE 1200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8906
Practice Address - Country:US
Practice Address - Phone:704-667-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC991207Q00000X
NC200600366207Q00000X
MN47587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909283Medicaid
NC1619949617Medicaid
SC009911Medicaid
MN213615500Medicaid
NCNC1139MMedicare PIN
SCAA72917772Medicare PIN
NC2401637Medicare PIN
NCNC1139HMedicare PIN
NCNC1139KMedicare PIN
NCNC1139BMedicare PIN
NCNC1139DMedicare PIN
NCNC1139PMedicare PIN
SC009911Medicaid
MN213615500Medicaid
NC5909283Medicaid
SCI319257366Medicare PIN
NCNC1139NMedicare PIN
NCNC1139OMedicare PIN
SCI319257180Medicare PIN
NC2401637AMedicare PIN
NCNC1139LMedicare PIN
MNP00293621Medicare PIN
NCNC1139CMedicare PIN
NCNC1139EMedicare PIN
NCNC1139FMedicare PIN
NCNC1139IMedicare PIN
MN080014171Medicare PIN