Provider Demographics
NPI:1023336724
Name:WALKER, MATTHEW SELMAN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SELMAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5000 ODONAVAN BLVD
Mailing Address - Street 2:STE 404
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-6351
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-369-8140
Practice Address - Street 1:5000 ODONAVAN BLVD
Practice Address - Street 2:STE 404
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-6351
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-369-8140
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2021-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.205276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2110471Medicaid
LA310090YJA2Medicare PIN