Provider Demographics
NPI:1962596353
Name:WALN, CURTIS L (MD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:WALN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 16TH ST STE C
Mailing Address - Street 2:BANNER INTERNAL MEDICINE - GREELEY
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5188
Mailing Address - Country:US
Mailing Address - Phone:970-350-5660
Mailing Address - Fax:970-350-5669
Practice Address - Street 1:2010 16TH ST STE C
Practice Address - Street 2:BANNER INTERNAL MEDICINE - GREELEY
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5188
Practice Address - Country:US
Practice Address - Phone:970-350-5660
Practice Address - Fax:970-350-5669
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020393207R00000X
CODR 0037400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87103010Medicaid
H03722Medicare UPIN
NM87103010Medicaid