Healthcare Provider Details

I. General information

NPI: 1063482115
Provider Name (Legal Business Name): THOMAS E WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 HIGH STREET
ONAGA KS
66521
US

IV. Provider business mailing address

716 HIGH STREET
ONAGA KS
66521
US

V. Phone/Fax

Practice location:
  • Phone: 785-889-7193
  • Fax:
Mailing address:
  • Phone: 785-889-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0416214
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: