Provider Demographics
NPI:1265450902
Name:WALTER, JENNIFER A (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14991 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-690-4891
Mailing Address - Fax:303-690-5082
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-690-4891
Practice Address - Fax:303-690-5082
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO40053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21575533Medicaid
496758Medicare ID - Type Unspecified
CO21575533Medicaid