MEDICARE: DR. RICHARD JOSEPH WALSH MD

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	207N00000X	Dermatology Physician	R6H83	MO

General Provider Information

NPI Number	:	1952385437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOSEPH WALSH MD

Provider Business Mailing Address
First Line	:	3917 SHERMAN AVENUE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3649
Country	:	US
Telephone Number	:	816-364-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 SHERMAN AVENUE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3649
Country	:	US
Telephone Number	:	816-364-6777
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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