Healthcare Provider Details

I. General information

NPI: 1033111760
Provider Name (Legal Business Name): ZANE T WALSH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 VILLAGE DR
FAYETTEVILLE NC
28304-3815
US

IV. Provider business mailing address

2930 VILLAGE DR
FAYETTEVILLE NC
28304-3815
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-9010
  • Fax: 910-829-9530
Mailing address:
  • Phone: 910-323-9010
  • Fax: 910-829-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number39135
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: