Provider Demographics
NPI:1861439796
Name:WALKER, GUDRUN STOCK (MD)
Entity Type:Individual
Prefix:
First Name:GUDRUN
Middle Name:STOCK
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:PO BOX 44123
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-4123
Mailing Address - Country:US
Mailing Address - Phone:318-222-1149
Mailing Address - Fax:318-425-2335
Practice Address - Street 1:1 SAINT MARY PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4343
Practice Address - Country:US
Practice Address - Phone:318-222-1149
Practice Address - Fax:318-425-2335
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD0181512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1953741Medicaid
LA5R323B134Medicare ID - Type Unspecified
LA1953741Medicaid