LARRY D WALLS MD PROF LLC (NPI# 1497912851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497912851 |
| Entity Type | Organization |
| Organization Name | LARRY D WALLS MD PROF LLC |
| Practice Address |
2001 Lake Ave Pueblo CO 81004-3538 |
| Practice Telephone | 7195640300 |
| Practice Fax Number | 7195640303 |
| Mailing Telephone | 7195640300 |
| Mailing Fax Number | 7195640303 |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-10-31 |
| Authorized Official Name | CAROLE J WALLS (OFFICE MANAGER) |
| Authorized Official Telephone | 7195640300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 16515 | CO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 80076807 | 05 |
| Street Address |
2001 LAKE AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81004-3538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669442422 | Krystal J Holderness Nakamura | Dermatology | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2006-01-25 |
| 1922351279 | Infectious Disease Specialist of Southern Colorado, Pllc | Clinic/Center | 2001 Lake Ave, Suite 2, Pueblo, CO 81004-3538 | 2012-10-24 |
| 1548409139 | Southern Colorado Dermatology Clinic PC | Dermatology | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2009-02-05 |
| 1558528919 | Kyra Hootman Do PC | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2008-05-21 |
| 1003012279 | Melchor Sipalay Md LLC | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2007-06-25 |
| 1437108131 | Kyra K Hootman | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3535 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780155929 | Renee C Lane | Nurse Practitioner | 1925 E. Orman Ave. Ste. A109, Pueblo, CO 81004 | 2018-12-16 |
| 1215406913 | Kaiser Foundation Healthplan of Colorado | Pharmacy | 2625 W. Pueblo Blvd, Pueblo, CO 81004 | 2018-11-26 |
| 1053895532 | Rebecka Ann Reatherford | Nurse Practitioner | St Mary-corwin Medical Center, 1008 Minnequa Ave, Pueblo, CO 81004 | 2018-09-20 |
| 1124510821 | Angela M Sillas-green | Counselor | 327 Colorado Ave., Pueblo, CO 81004 | 2018-05-30 |
| 1558898569 | Alexandra R B King | Family Medicine | Southern Colorado Family Medicine, 902 Lakeview Avenue, Pueblo, CO 81004 | 2017-05-22 |
| 1578098752 | James Williams | Counselor | 414 Broadway Ave, Pueblo, CO 81004 | 2017-04-26 |
| 1740732601 | Valerie A Senger | Counselor | 635 W Corona Ave Ste 214, Pueblo, CO 81004 | 2016-10-26 |
| 1194111500 | A New Leaf Therapy, Pllc | Community/Behavioral Health | 327 Colorado Ave, Pueblo, CO 81004 | 2015-04-13 |
| 1619371671 | Mariah Mcginnis | Registered Nurse | 1232 Van Buren St., Pueblo, CO 81004 | 2014-10-20 |
| 1730593112 | Maritza Martinez | Registered Nurse | 1026 Wabriendo Ave, Pueblo, CO 81004 | 2014-06-13 |
| Find all providers in zip 81004 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518434349 | Mariam Rahim | Internal Medicine | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-10-30 |
| 1003308222 | Julia Mcneice | Internal Medicine | Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-06-04 |
| 1689164857 | Jessica Sels | Internal Medicine | Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 | 2018-05-14 |
| 1699200535 | Nida Firdous | Internal Medicine | 400 W 16th St # 105, Pueblo, CO 81003-2781 | 2017-04-28 |
| 1134653876 | Logan Reimer | Internal Medicine | 2511 N Greenwood St, Pueblo, CO 81003-3649 | 2017-04-19 |
| 1245682020 | Paul S Bongat | Internal Medicine | 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 | 2016-07-06 |
| 1013368596 | Daniel R Long | Internal Medicine | 411 West 14th Street, Pueblo, CO 81003 | 2016-06-27 |
| 1730507740 | Shannan Patterson | Internal Medicine | 1008 Minnequa Ave Ste 1124, Pueblo, CO 81004-3733 | 2014-04-07 |
| 1932544855 | Megan Christine Reichmuth | Internal Medicine | 1600 N Grand Ave Ste 140, Pueblo, CO 81003-2755 | 2013-05-06 |
| 1851650188 | Anh-thu Qui Nguyen | Internal Medicine | 4722 Eagleridge Circle, Pueblo, CO 81008-2120 | 2012-05-07 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.