Basic Information
| Provider Information | |||||||||
| NPI: | 1023336724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | SELMAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 ODONAVAN BLVD | ||||||||
| Address2: | STE 404 | ||||||||
| City: | WALKER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707856351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655500 | ||||||||
| FaxNumber: | 2253698140 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 ODONAVAN BLVD | ||||||||
| Address2: | STE 404 | ||||||||
| City: | WALKER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707856351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655500 | ||||||||
| FaxNumber: | 2253698140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD.205276 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2110471 | 05 | LA | MEDICAID |