Healthcare Provider Details

I. General information

NPI: 1932161999
Provider Name (Legal Business Name): GURMUKH S WALHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542B WHITE OAK ST
ASHEBORO NC
27203-4710
US

IV. Provider business mailing address

542B WHITE OAK ST
ASHEBORO NC
27203-4710
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-4171
  • Fax: 336-629-4345
Mailing address:
  • Phone: 336-629-4171
  • Fax: 336-629-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00-23451
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: