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General NPI Number Information
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NPI Number | 1043341480
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Entity Type | Organization
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Legal Business Name | PATRICK WALSH MD PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 1622 8TH AVE 120
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City | FORT WORTH
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State | TX
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Zip | 76104-4155
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Country | US
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Telephone | 817-923-8220
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Fax | 817-923-9004
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Provider Business Mailing Address
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Address Line | 1622 8TH AVE 120
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City | FORT WORTH
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State | TX
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Zip | 76104-4155
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Country | US
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Telephone | 817-923-8220
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Fax | 817-923-9004
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK WALSH
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Credential | M.D.
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Telephone | 817-923-8220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | H5814
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License Number State | TX
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