Healthcare Provider Details

I. General information

NPI: 1720158777
Provider Name (Legal Business Name): PHILIP D WALSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 7025
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-5872
  • Fax: 513-636-3529
Mailing address:
  • Phone: 513-636-2039
  • Fax: 866-851-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number35046055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: