Healthcare Provider Details

I. General information

NPI: 1356347835
Provider Name (Legal Business Name): SHARON WALSTON KOBOS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON P WALSTON DPM

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111-2672
US

IV. Provider business mailing address

5111 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111-2672
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-1000
  • Fax: 505-880-1002
Mailing address:
  • Phone: 505-880-1000
  • Fax: 505-880-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: