Provider Demographics
NPI:1972973816
Name:WALKER, JONATHAN (PA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:181 W MEADOW DR
Mailing Address - Street 2:STE 400
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-5242
Mailing Address - Country:US
Mailing Address - Phone:970-476-1100
Mailing Address - Fax:970-479-5813
Practice Address - Street 1:180 S FRONTAGE RD W STE 2700
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5038
Practice Address - Country:US
Practice Address - Phone:970-446-7220
Practice Address - Fax:970-479-9166
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0004685363A00000X
CO4685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant