Provider Demographics
NPI:1801383146
Name:STEWART, WALTER COLIN (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:COLIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:COLIN
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:750 HOSPITAL LOOP
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-8750
Mailing Address - Country:US
Mailing Address - Phone:970-824-9411
Mailing Address - Fax:
Practice Address - Street 1:750 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-8750
Practice Address - Country:US
Practice Address - Phone:970-824-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0007307207Q00000X, 390200000X
CODR.0063685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000163515Medicaid