Provider Demographics
NPI:1659338994
Name:WALTER, ANGELA SUE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SUE
Last Name:WALTER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 E HARMONY RD STE 190
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3430
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0051591207Q00000X
TNMD37517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93625715Medicaid
CO023147OtherKAISER COMMERCIAL NUMBER
TN3336621Medicaid
COCOA109312Medicare PIN
TN3336621Medicaid
COCOA109312Medicare PIN