Provider Demographics
NPI:1891751988
Name:WALKER, FREDERIC BARBER IV (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:BARBER
Last Name:WALKER
Suffix:IV
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 1:659 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8319
Mailing Address - Country:US
Mailing Address - Phone:970-245-7533
Mailing Address - Fax:
Practice Address - Street 1:659 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8319
Practice Address - Country:US
Practice Address - Phone:970-245-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01173137Medicaid
CO110135001Medicare PIN
COB54803Medicare UPIN
CO01173137Medicaid
COCE2684Medicare PIN