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NPI Code Detail

MEDICARE: DOUGLAS A WALSH SR. D.O.

MEDICARE: DOUGLAS A WALSH SR. D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS3589FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083610257
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS A WALSH SR. D.O.
Provider Business Mailing Address
First Line : 4440 FRUITVILLE RD
Second Line :
City : SARASOTA
State : FL
Zip : 34232-1926
Country : US
Telephone Number : 941-366-0134
Fax Number : 941-404-1760
Provider Business Practice Location Address
First Line : 1231 N TUTTLE AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34237-3116
Country : US
Telephone Number : 941-366-0134
Fax Number : 941-951-1795
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 06/25/2019

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