Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 18986 | SC |
Y | 2086S0105X | Surgery of the Hand | 18986 | SC |
NPI | 1427012491 |
---|---|
Provider Name | Dr. John Joseph Walsh IV |
First Address | Belfast, ME 04915-4473 |
Second Address | Columbia, SC 29203-6808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 06/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0534520001 | MEDICARE DME (01) | SC |
189860 | (05) | SC |
AA46323357 | MEDICARE PTAN (01) | SC |
G70822 | (02) |