Provider Demographics
NPI:1043506413
Name:WALKER, JAMES ELY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELY
Last Name:WALKER
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 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8719
Mailing Address - Country:US
Mailing Address - Phone:719-657-4102
Mailing Address - Fax:719-657-4106
Practice Address - Street 1:310 COUNTY ROAD 14
Practice Address - Street 2:
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-8719
Practice Address - Country:US
Practice Address - Phone:719-657-4102
Practice Address - Fax:719-657-4106
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4832207Q00000X
CO52335207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO025524OtherKAISER COMMERCIAL NUMBER
CO306142YNJJOtherMEDICARE PTAN
CO85933864Medicaid
CO025524OtherKAISER COMMERCIAL NUMBER