Healthcare Provider Details

I. General information

NPI: 1043301740
Provider Name (Legal Business Name): ALEXANDER CRAIG WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 407
PASADENA CA
91105-2562
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 380
LOS ANGELES CA
90017-4886
US

V. Phone/Fax

Practice location:
  • Phone: 262-041-4106
  • Fax: 213-975-9118
Mailing address:
  • Phone: 213-483-8810
  • Fax: 213-975-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA079504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: