Robert L. Walker, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D1657 Issued in ID

Practice address

35 Madison Professional Park
Rexburg, ID 83440-2057

Phone

(208) 356-0711

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Madison Park Dental Center PLLC

  • Dentist
  • Rexburg, ID
  • NPI 1093849226
  NPD (past) Authorized official
• Madison Park Dental Center

  • General Practice Dentistry
  • Rexburg, ID
  • NPI 1831545102
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548271273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 MADISON PROFESSIONAL PARK",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402057",
            "telephone_number": "208-356-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MADISON PROFESSIONAL PARK",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402057",
            "telephone_number": "208-356-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "ROBERT",
        "middle_name": "L.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D1657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "6I120",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brayden Kay Waddoups
• Emily Brianne Wagner, LMSW
• Wal-Mart Stores, Inc. (Walmart Vision Center 30-1878)
• Walgreen Co (Walgreens #9918)
• Kyle Walker, PHD., LMFT
• Sara Walker
• Walmart Inc. (Walmart Pharmacy 10-1878)
• Elizabeth Ward
• Hillary Rose Wardell, LPC
• Joseph Watson, MD

• Dentist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.