Provider Demographics
NPI:1013005024
Name:VERNON, WALTER B (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:B
Last Name:VERNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8490 E CRESCENT PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2815
Mailing Address - Country:US
Mailing Address - Phone:303-957-1310
Mailing Address - Fax:303-761-4252
Practice Address - Street 1:4545 E 9TH AVE STE 375
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3987
Practice Address - Country:US
Practice Address - Phone:303-952-2300
Practice Address - Fax:303-722-0201
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-06-06
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Provider Licenses
StateLicense IDTaxonomies
CO31476208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314764Medicaid
CO01314764Medicaid
CO436138ZLF7Medicare PIN
COC86913Medicare UPIN