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NPI Code Detail

MEDICARE: LYNDA WALTERS M.D.

MEDICARE: LYNDA WALTERS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0505XAdult Medicine Physician32875CO

General Provider Information

NPI Number : 1003917113
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDA WALTERS M.D.
Provider Business Mailing Address
First Line : PO BOX 297
Second Line :
City : MESA
State : CO
Zip : 81643-0297
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 58128 HIGHWAY 330
Second Line :
City : COLLBRAN
State : CO
Zip : 81624-9502
Country : US
Telephone Number : 970-487-3565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 01/26/2010

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