Individual
DR. ELOISA S. WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 E IDAHO ST, SUITE 304, BOISE, ID 83712-6223
(208) 336-9188
(208) 336-2636
Mailing address
190 E BANNOCK ST, BOISE, ID 83712
(208) 337-4254
(208) 337-4328
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
M6279
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010017912
BLUE SHIELD
ID
05
—
0027267
—
ID
01
—
121173
OMAP (OREGON MEDICAID)
OR
01
—
12799
BLUE CROSS
ID
Enumeration date
05/15/2006
Last updated
09/18/2012
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