Healthcare Provider Details

I. General information

NPI: 1730374604
Provider Name (Legal Business Name): WILLIAM JOSEPH WALSH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 03/07/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 PENNSYLVANIA AVE
OGDEN UT
84401-3320
US

IV. Provider business mailing address

2740 PENNSYLVANIA AVE
OGDEN UT
84401-3320
US

V. Phone/Fax

Practice location:
  • Phone: 801-675-5624
  • Fax:
Mailing address:
  • Phone: 385-280-6337
  • Fax: 801-675-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number6054241-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5054241-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: