Provider Demographics
NPI:1952398687
Name:WALKER, BRENT L (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:L
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 1:800 FAIR PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1720
Mailing Address - Country:US
Mailing Address - Phone:501-500-3500
Mailing Address - Fax:501-777-3519
Practice Address - Street 1:800 FAIR PARK BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1720
Practice Address - Country:US
Practice Address - Phone:501-500-3500
Practice Address - Fax:501-777-3519
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1138207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR18432000020OtherQUAL CHOICE (LRPM)
AR71033532430OtherQUAL CHOICE
AR050067293OtherRAILROAD MEDICARE (LRPM)
ARS00826OtherNOVASYS
AR171973300OtherUS DEPT. OF LABOR OWCP
AR050067294OtherRAILROAD MEDICARE
AR137517001Medicaid
AR770132101OtherARKANSAS BREASTCARE
AR5L114OtherBLUE CROSS BLUE SHIELD
AR5L114OtherBLUE CROSS BLUE SHIELD
AR770132101OtherARKANSAS BREASTCARE
ARS00826OtherNOVASYS