Provider Demographics
NPI:1629166053
Name:WALMER, MARK STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:WALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:655 S DOBSON RD
Mailing Address - Street 2:A201
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5669
Mailing Address - Country:US
Mailing Address - Phone:480-821-3821
Mailing Address - Fax:186-677-7239
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:A201
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5669
Practice Address - Country:US
Practice Address - Phone:480-821-3821
Practice Address - Fax:186-677-7239
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ15974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ62340OtherMEDICARE Z62340
AZ274639Medicaid
D00529Medicare UPIN