MEDICARE: DR. JOHN STEPHEN WALSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	210572	NY
2	207Q00000X	Family Medicine Physician	274001	MA
3	207Q00000X	Family Medicine Physician	ME145947	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033131883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN STEPHEN WALSH MD

Provider Business Mailing Address
First Line	:	313 SW PINE ISLAND RD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2043
Country	:	US
Telephone Number	:	239-458-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 SW PINE ISLAND RD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2043
Country	:	US
Telephone Number	:	239-458-6755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	01/03/2025

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