Basic Information
| Provider Information | |||||||||
| NPI: | 1811945553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDEN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3920 N UNION BLVD | ||||||||
| Address2: | STE 330 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809074900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707272 | ||||||||
| FaxNumber: | 7195709030 | ||||||||
| Practice Location | |||||||||
| Address1: | 3920 N UNION BLVD | ||||||||
| Address2: | STE 330 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809074900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707272 | ||||||||
| FaxNumber: | 7195709030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/13/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | CO30715 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | CO30715 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 208100000X | CO30715 | CO | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 01307156 | 05 | CO | MEDICAID | WAJ3018 | 01 | CO | ANTHEM BCBS | OTHER |