Provider Demographics
NPI:1700923018
Name:WALKER, GRANT EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:EDWARD
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5880 S HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9447
Mailing Address - Country:US
Mailing Address - Phone:928-402-1175
Mailing Address - Fax:928-425-7903
Practice Address - Street 1:3798 JANES RD STE 6
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4745
Practice Address - Country:US
Practice Address - Phone:208-785-4665
Practice Address - Fax:208-785-2199
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11112207XS0117X
WY7587A207XS0117X
AZ30958207XS0117X
CODR32874207XS0117X
IDM8790207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5470815OtherCCN
ID000010143629OtherBLUE SHIELD
CO801254OtherMEDICARE
2093784OtherFIRST HEALTH
ID54841OtherBLUE CROSS
106308600OtherDEPT OF LABOR
ID806635100Medicaid
CO801254OtherMEDICARE
2093784OtherFIRST HEALTH