Healthcare Provider Details

I. General information

NPI: 1225028202
Provider Name (Legal Business Name): ROBERT THOMAS WALSH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N ALLEN ST
ROBINSON IL
62454-1168
US

IV. Provider business mailing address

1101 N ALLEN ST
ROBINSON IL
62454-1168
US

V. Phone/Fax

Practice location:
  • Phone: 618-546-3800
  • Fax: 618-544-4410
Mailing address:
  • Phone: 618-546-3800
  • Fax: 618-544-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036088328
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: