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Organization
WALKER SPINE AND SPORTS SPECIALISTS
Active
Organization
WALKER SPINE AND SPORTS SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY C WALKER MD (OWNER)
(208) 227-1200
Entity
Organization
Contact information
Practice address
2319 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 227-1200
(208) 227-1212
Mailing address
2319 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 227-1200
(208) 227-1212
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
E65389
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010140195
REGENCE BLUE SHIELD
ID
01
—
204221200
US DEPT OF LABOR
ID
05
—
806811100
—
ID
01
—
8H989
BLUE CROSS
ID
01
—
DA4495
RAILROAD MEDICARE
ID
Enumeration date
10/06/2006
Last updated
03/10/2016
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