Provider Demographics
NPI:1700834363
Name:WALKER, STEPHANIE ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ROBIN
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:109 PHYSICIANS DR STE A
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2446
Practice Address - Country:US
Practice Address - Phone:864-797-9150
Practice Address - Fax:864-797-9155
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37333208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC373330Medicaid
FL99267OtherBCBS
FLME84475OtherSTATE LICENSE
FL71617OtherBCBS
FLME84475OtherSTATE LICENSE
FLH93907Medicare UPIN
P00650339Medicare PIN
SCSC44675019Medicare PIN
SCSC44673365Medicare PIN
FL71617OtherBCBS
FLK8115Medicare PIN