Provider Demographics
NPI:1699717629
Name:WALTERS, JEANNINE T (DO)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:T
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:T
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 173817
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3817
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:2000 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5006
Practice Address - Country:US
Practice Address - Phone:970-635-4071
Practice Address - Fax:970-635-4177
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO271207P00000X
CODR.0049739207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83809261Medicaid