Healthcare Provider Details

I. General information

NPI: 1588568729
Provider Name (Legal Business Name): WALKER LAWRENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ARAPAHOE AVE
BOULDER CO
80303-1131
US

IV. Provider business mailing address

1209 HARRISON CT
BOULDER CO
80303-1138
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7000
  • Fax:
Mailing address:
  • Phone: 210-218-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number211729
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: