Individual
DR. WALTER DANTE CONWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1375 E 20TH AVE, DENVER, CO 80205-5422
(303) 338-4545
Mailing address
393 E WALNUT ST, PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FL, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
51324
CO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
51324
CO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A159124
CA
207RP1001X
Pulmonary Disease Physician
51324
CO
207RP1001X
Pulmonary Disease Physician
A159124
CA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
A159124
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027190
KAISER COMMERCIAL NUMBER
CO
05
—
34877843
—
CO
Enumeration date
06/28/2008
Last updated
11/05/2019
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