Provider Demographics
NPI:1659320943
Name:WALKER, ROBERT RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RICARDO
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 1:1007 GROVE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4630
Mailing Address - Country:US
Mailing Address - Phone:864-558-0405
Mailing Address - Fax:864-558-0407
Practice Address - Street 1:1007 GROVE RD
Practice Address - Street 2:SUITE D
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4630
Practice Address - Country:US
Practice Address - Phone:864-558-0405
Practice Address - Fax:864-558-0407
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6470Medicaid
SC110230171OtherRR MEDICARE
SC195345Medicaid
SCAA37527951Medicare PIN
G70141Medicare UPIN
SCG701413640Medicare PIN
SC195345Medicaid
SC110230171OtherRR MEDICARE