Provider Demographics
NPI:1558349696
Name:WALKER, EDWIN LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LANCE
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:STE 380
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6023
Mailing Address - Country:US
Mailing Address - Phone:303-595-2700
Mailing Address - Fax:303-595-2777
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:STE 380
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6023
Practice Address - Country:US
Practice Address - Phone:303-595-2700
Practice Address - Fax:303-595-2777
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19193208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COWAR4828OtherBLUE CROSS
CO84061667002OtherPACIFICARE
CO01191931Medicaid
COWAR4828OtherBLUE CROSS
CO84061667002OtherPACIFICARE