Healthcare Provider Details

I. General information

NPI: 1912080946
Provider Name (Legal Business Name): JAMES S. WALSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TALLMAN AVE NW
SEATTLE WA
98107-3932
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 206-781-6209
  • Fax: 206-781-6183
Mailing address:
  • Phone: 206-781-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00032776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: