Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 005628 | AZ |
Y | 208600000X | Surgeon | 005628 | AZ |
N | 2086S0122X | Plastic and Reconstructive Surgery | 47139 | MN |
NPI | 1275504920 |
---|---|
Provider Name | Molly F Walsh |
First Address | Scottsdale, AZ 85260-3953 |
Second Address | Scottsdale, AZ 85254-4615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 22/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
423030200 | (05) | MN |
BW8834067 | DEA LICENSE (01) | |
I06416 | (02) |