Organization
LARRY D WALLS MD PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLE J WALLS (OFFICE MANAGER)
(719) 564-0300
Entity
Organization
Contact information
Practice address
2001 LAKE AVE, PUEBLO, CO 81004-3538
(719) 564-0300
(719) 564-0303
Mailing address
2001 LAKE AVE, PUEBLO, CO 81004-3538
(719) 564-0300
(719) 564-0303
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16515
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80076807
—
CO
Enumeration date
05/21/2008
Last updated
10/31/2008
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