Provider Demographics
NPI:1811945553
Name:WALDEN, DAVID LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:WALDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3920 N UNION BLVD
Mailing Address - Street 2:STE 330
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4900
Mailing Address - Country:US
Mailing Address - Phone:719-570-7272
Mailing Address - Fax:719-570-9030
Practice Address - Street 1:3920 N UNION BLVD
Practice Address - Street 2:STE 330
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4900
Practice Address - Country:US
Practice Address - Phone:719-570-7272
Practice Address - Fax:719-570-9030
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO30715207X00000X, 207XX0005X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01307156Medicaid
COWAJ3018OtherANTHEM BCBS
CO01307156Medicaid
COJ3018Medicare PIN