Healthcare Provider Details

I. General information

NPI: 1255309340
Provider Name (Legal Business Name): JOSEPH BAILEY WALSH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 4TH AVE NE
BRADENTON FL
34208-5412
US

IV. Provider business mailing address

4654 E STATE ROAD 64 STE 509
BRADENTON FL
34208-9029
US

V. Phone/Fax

Practice location:
  • Phone: 941-216-7889
  • Fax: 941-417-8008
Mailing address:
  • Phone: 941-243-9613
  • Fax: 941-417-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: