Provider Demographics
NPI:1922076546
Name:WALKER, KIRK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:WILLIAM
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 1:777 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3421
Mailing Address - Country:US
Mailing Address - Phone:503-485-4787
Mailing Address - Fax:503-485-4789
Practice Address - Street 1:1501 NE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6051
Practice Address - Country:US
Practice Address - Phone:541-382-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17301207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00134062OtherRAILROAD MEDICARE
OR030879Medicaid
OR831646001OtherBCBS
OR030879Medicaid
ORF27184Medicare UPIN