Healthcare Provider Details

I. General information

NPI: 1871648493
Provider Name (Legal Business Name): TOM JOSEPH WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HOSPITAL ROAD
SCHURZ NV
89427
US

IV. Provider business mailing address

PO BOX C
SCHURZ NV
89427-0502
US

V. Phone/Fax

Practice location:
  • Phone: 775-773-2005
  • Fax: 775-773-2395
Mailing address:
  • Phone: 775-773-2005
  • Fax: 775-773-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5515
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: