MEDICARE: DR. JONATHAN WALTER 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
1	207R00000X	Internal Medicine Physician	28715	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427055235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN WALTER M.D.

Provider Business Mailing Address
First Line	:	1707 COLE BLVD
Second Line	:	STE 250
City	:	GOLDEN
State	:	CO
Zip	:	80401-3220
Country	:	US
Telephone Number	:	303-716-8013
Fax Number	:	303-716-8056

Provider Business Practice Location Address
First Line	:	9950 W 80TH AVE
Second Line	:	#23
City	:	ARVADA
State	:	CO
Zip	:	80005-3927
Country	:	US
Telephone Number	:	303-425-1018
Fax Number	:	303-432-4770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/21/2010

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