Individual
LARRY D WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 N GRAND AVENUE, SUITE 150, PUEBLO, CO 81003-2755
(719) 595-7700
(719) 595-7719
Mailing address
1600 N GRAND AVENUE, SUITE 150, PUEBLO, CO 81003-2755
(719) 595-7700
(719) 595-7719
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16515
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01165158
—
CO
Enumeration date
05/03/2006
Last updated
09/11/2012
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