Basic Information
| Provider Information | |||||||||
| NPI: | 1083619910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 W LUGONIA AVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923749703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095571600 | ||||||||
| FaxNumber: | 9095571732 | ||||||||
| Practice Location | |||||||||
| Address1: | 29099 HOSPITAL ROAD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | LAKE ARROWHEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097266100 | ||||||||
| FaxNumber: | 9095571745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 07/05/2012 | ||||||||
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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 | 207X00000X | C42773 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 20024497 | 01 | CA | RAILROAD MEDICARE | OTHER |