Healthcare Provider Details

I. General information

NPI: 1023014586
Provider Name (Legal Business Name): PAUL EDWARD WALSHAW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S OCOTILLO AVE
BENSON AZ
85602-6403
US

IV. Provider business mailing address

2149 E WARNER RD STE 102
TEMPE AZ
85284-3495
US

V. Phone/Fax

Practice location:
  • Phone: 520-623-2642
  • Fax: 520-327-9300
Mailing address:
  • Phone: 480-610-6100
  • Fax: 480-610-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number24073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: