Provider Demographics
NPI:1811030935
Name:WILLIAM P WALKER III
Entity Type:Organization
Organization Name:WILLIAM P WALKER III
Other - Org Name:SEASIDE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:910-755-6232
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459
Mailing Address - Country:US
Mailing Address - Phone:910-755-6232
Mailing Address - Fax:910-755-5984
Practice Address - Street 1:204 SMITH AVE
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-755-6232
Practice Address - Fax:910-755-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985373Medicaid
NC85373OtherBCBS
=========OtherTAX #
NC8985373Medicaid
NC85373OtherBCBS
NC2216748Medicare ID - Type Unspecified