Healthcare Provider Details

I. General information

NPI: 1255372736
Provider Name (Legal Business Name): PETER WALSH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S COTTONWOOD RD STE 200
BOZEMAN MT
59718-4208
US

IV. Provider business mailing address

915 HIGHLAND BLVD ATTN PFS CREDENTIALING
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5336
  • Fax: 406-414-5337
Mailing address:
  • Phone: 406-414-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number59075
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: