Provider Demographics
NPI: | 1831142181 |
---|---|
Name: | WALKER, SCOTT G (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | SCOTT |
Middle Name: | G |
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: | 250 N SHADELAND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46219-4959 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | 317-567-2191 |
Practice Address - Street 1: | 705 RILEY HOSPITAL DR |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46202-5109 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-944-9981 |
Practice Address - Fax: | 317-944-0282 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-18 |
Last Update Date: | 2020-11-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01041621 | 207L00000X, 207LP3000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207LP3000X | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 200085110 | Medicaid | |
IN | 237400L | Medicare PIN | |
IN | G31589 | Medicare UPIN | |
IN | 095200CCC | Medicare PIN |