Larry D Walls MD Prof LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

16515 Issued in CO

Legal business name

LARRY D WALLS MD PROF LLC

Practice address

2001 Lake Ave
Pueblo, CO 81004-3538

Phone

(719) 564-0300

Fax

(719) 564-0303

NPI assigned

May 21, 2008

Last updated

Oct 31, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carole J Walls

Title

Office Manager

Phone

(719) 564-0300

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225411200000",
    "number": "1497912851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 LAKE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043538",
            "telephone_number": "719-564-0300",
            "fax_number": "719-564-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 LAKE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043538",
            "telephone_number": "719-564-0300",
            "fax_number": "719-564-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY D WALLS MD PROF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-10-31",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-564-0300"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "16515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80076807",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rene Larrabee, LPC
• Laurie Larrick, B A
• Lars Van Etten MD LLC
• Darci Larsen, RPH
• Gregory S Larsen, MD
• Brandon John Larson
• Jean A Larson, MSW LCSW

• Internal Medicine Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Internal Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.