Active NPI
Larry D Walls, MD
- Internal Medicine Physician
- Pueblo, CO
National Provider Identifier
1124086426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 16515
- Practice address
- 1600 N Grand Avenue
Suite 150
Pueblo, CO 81003-2755 - Phone
- (719) 595-7700
- Fax
- (719) 595-7719
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 16515 | CO | Primary |
Addresses
Primary practice location
1600 N Grand Avenue
Suite 150
Pueblo, CO 81003-2755
Mailing address
1600 N Grand Avenue
Suite 150
Pueblo, CO 81003-2755
Phone (719) 595-7700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01165158 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16515 | CO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpatient Consultants of Colorado, PC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Denver, CO
- NPI 1538461256
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347321600000",
"number": "1124086426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 N GRAND AVENUE",
"address_2": "SUITE 150",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032755",
"telephone_number": "719-595-7700",
"fax_number": "719-595-7719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 N GRAND AVENUE",
"address_2": "SUITE 150",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032755",
"telephone_number": "719-595-7700",
"fax_number": "719-595-7719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLS",
"first_name": "LARRY",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2012-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "16515",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01165158",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.