Provider Demographics
NPI:1649475617
Name:HARRY J WALTER DO PC
Entity type:Organization
Organization Name:HARRY J WALTER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BLYTHE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-286-1960
Mailing Address - Street 1:8380 ZUNI ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4778
Mailing Address - Country:US
Mailing Address - Phone:303-286-1960
Mailing Address - Fax:303-286-1964
Practice Address - Street 1:8380 ZUNI ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80221-4778
Practice Address - Country:US
Practice Address - Phone:303-286-1960
Practice Address - Fax:303-286-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01158930Medicaid
COC810137Medicare PIN
CO810134Medicare PIN
COC810134Medicare PIN
CO01158930Medicaid