Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0011X | Interventional Cardiology | A123966 | CA |
Y | 207RI0011X | Interventional Cardiology | M-15215 | ID |
NPI | 1063674505 |
---|---|
Provider Name | Dr. Joseph Aloysius Walsh Iii |
First Address | Meridian, ID 83642 |
Second Address | Boise, ID 83704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 24/07/2020 |