Basic Information
| Provider Information | |||||||||
| NPI: | 1184664229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40480 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366400480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514705842 | ||||||||
| FaxNumber: | 2514705809 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 CENTER ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366043304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514151475 | ||||||||
| FaxNumber: | 2514151476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 23523 | AL | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51097754 | 01 | AL | BLUE CROSS | OTHER | 51097753 | 01 | AL | BLUE CROSS | OTHER | 00122509 | 05 | MS | MEDICAID | 1431257 | 05 | LA | MEDICAID | 17-10541 | 01 | AL | UNITED HEALTH CARE | OTHER |