Provider Demographics
NPI:1184614315
Name:WALKER, IAN G (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:G
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6510-A S ACADEMY BLVD
Mailing Address - Street 2:#238
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8691
Mailing Address - Country:US
Mailing Address - Phone:719-632-1818
Mailing Address - Fax:719-632-4615
Practice Address - Street 1:2727 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6231
Practice Address - Country:US
Practice Address - Phone:719-632-1818
Practice Address - Fax:719-632-4615
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2014-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO23671208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01236710Medicaid
CO01236710Medicaid
CO40483Medicare PIN