Provider Demographics
NPI:1063825693
Name:WALPOLE, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:WALPOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2643 PATTERSON RD STE 401
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1937
Mailing Address - Country:US
Mailing Address - Phone:970-298-3884
Mailing Address - Fax:370-372-0995
Practice Address - Street 1:2643 PATTERSON RD STE 401
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1937
Practice Address - Country:US
Practice Address - Phone:970-298-3884
Practice Address - Fax:370-372-0995
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR100542086S0102X, 2086S0127X, 2086S0129X, 208600000X
CODR.00619012086S0102X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery