MEDICARE: MR. ROBERT E. WALSH PA-C

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
1	363A00000X	Physician Assistant	PA9103429	FL
2	363AS0400X	Surgical Physician Assistant	PA9103429	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1639137839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT E. WALSH PA-C

Provider Business Mailing Address
First Line	:	709 S HARBOR CITY BLVD
Second Line	:	SUITE 100
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1938
Country	:	US
Telephone Number	:	321-725-2225
Fax Number	:	321-802-5804

Provider Business Practice Location Address
First Line	:	709 S HARBOR CITY BLVD
Second Line	:	SUITE 100
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1938
Country	:	US
Telephone Number	:	321-725-2225
Fax Number	:	321-802-5804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/08/2015

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