Provider Demographics
NPI:1790880326
Name:WALKER, DIANE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
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 1:23708 NW 194TH DR
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-7022
Mailing Address - Country:US
Mailing Address - Phone:386-454-2270
Mailing Address - Fax:
Practice Address - Street 1:149 NE 241 ST
Practice Address - Street 2:
Practice Address - City:CROSS CITY
Practice Address - State:FL
Practice Address - Zip Code:32628-3305
Practice Address - Country:US
Practice Address - Phone:352-498-1360
Practice Address - Fax:352-498-1359
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047108207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036568800Medicaid
FLP00096973OtherRAILROAD MCR
FL04488OtherBCBS
FL04488BMedicare ID - Type Unspecified
FLD51034Medicare UPIN