Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 3861 | SD |
NPI | 1053386896 |
---|---|
Provider Name | Patrick M Walsh |
First Address | Dakota Dunes, SD 57049-5327 |
Second Address | Dakota Dunes, SD 57049-5327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E43209 | (02) | SD |