Provider Demographics
NPI:1801887971
Name:WALKER, BRENT E (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:E
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 1:1827 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2168
Mailing Address - Country:US
Mailing Address - Phone:814-864-4048
Mailing Address - Fax:814-868-0011
Practice Address - Street 1:1827 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2168
Practice Address - Country:US
Practice Address - Phone:814-864-4048
Practice Address - Fax:814-868-0011
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027222E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106-3570Medicaid
PA131034OtherBLUE SHIELD
PA106-3570Medicaid
PAWA131034Medicare ID - Type Unspecified