Provider Demographics
NPI:1679564918
Name:LUCE, WALTER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DAVID
Last Name:LUCE
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 1:11547 E 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1273
Mailing Address - Country:US
Mailing Address - Phone:303-444-5689
Mailing Address - Fax:303-449-2933
Practice Address - Street 1:11547 E 25TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1273
Practice Address - Country:US
Practice Address - Phone:303-444-5689
Practice Address - Fax:303-449-2933
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01263870Medicaid
COD24793Medicare UPIN
CO55991Medicare ID - Type UnspecifiedINTERNAL MEDICINE