Provider Demographics
NPI:1104809714
Name:WALKER, BRIAN K (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
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 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3550
Practice Address - Street 1:681 4TH AVE N
Practice Address - Street 2:LUGERT WEST BUILDING
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5729
Practice Address - Country:US
Practice Address - Phone:239-434-2622
Practice Address - Fax:239-434-6876
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78859207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830008285OtherRR MEDICARE
FL257926000Medicaid
FL49353YMedicare PIN
FLC29168Medicare UPIN
FL49353XMedicare PIN