Basic Information
| Provider Information | |||||||||
| NPI: | 1700923018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | GRANT | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5880 S HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855019447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284021175 | ||||||||
| FaxNumber: | 9284257903 | ||||||||
| Practice Location | |||||||||
| Address1: | 3798 JANES RD STE 6 | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087854665 | ||||||||
| FaxNumber: | 2087852199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 11112 | MT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 7587A | WY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 30958 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | DR32874 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | M8790 | ID | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 5470815 | 01 | CCN | OTHER | 000010143629 | 01 | ID | BLUE SHIELD | OTHER | 801254 | 01 | CO | MEDICARE | OTHER | 2093784 | 01 | FIRST HEALTH | OTHER | 54841 | 01 | ID | BLUE CROSS | OTHER | 106308600 | 01 | DEPT OF LABOR | OTHER | 806635100 | 05 | ID | MEDICAID |