Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | M6984 | ID |
NPI | 1730195298 |
---|---|
Provider Name | Dr. Eric D Walker |
First Address | Idaho Falls, ID 83404-7407 |
Second Address | Idaho Falls, ID 83404-7407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 14/11/2012 |