Provider Demographics
NPI:1760472203
Name:WALKER, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
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 1:416E MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-1154
Mailing Address - Country:US
Mailing Address - Phone:907-545-1017
Mailing Address - Fax:
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN
Practice Address - Street 2:KUSKO CLINIC
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-6300
Practice Address - Fax:907-543-6250
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7366207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34606200Medicaid
I25369Medicare UPIN
WI000224160Medicare PIN
WI34606200Medicaid